Abstract
Discogenic back pain remains a controversial entity. Many spinal surgeons believe that certain instances of nonradicular back pain are caused by an abnormal intervertebral disc. The usefulness of surgery, however, to effectively treat this condition, is unclear, with mixed results reported in the literature. Central to the difficulty in effectively treating discogenic back pain is the difficulty of accurate diagnosis. Magnetic resonance imaging demonstrating the classic “black disc” appearance is usually suggestive, but provocative discography has been also used as a method of further confirmation. Reproduction of the patient’s typical pain after injection of contrast into the disc is considered to implicate the disc as the pain generator. In this study, Smith et al. retrospectively compare outcomes of patients undergoing surgical and nonsurgical management of back pain after provocative discography. The groups are similar in age, pain, body mass index, smoking, and number of levels. Clinical outcomes, using a range of standardized pain and functional scores, and with good length of follow-up, were similar between both groups. Smith et al. then perform a regression analysis demonstrating similar outcomes in patients undergoing surgical and nonsurgical management.
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