Cervical discography in discogenic pain syndrome and its predictive value for cervical fusion

Abstract

We have reviewed 27 patients who underwent fusion of a total of 39 cervical levels for discogenic pain syndrome. All patients were diagnosed by positive discography defined as provocation of their characteristic pain on a Adams type 3–5 contrast distribution pattern. The mean age of the patients was 46.4 years and the follow-up averaged 16.2 months (range 9–42 months). Fusion was performed through a ventral approach with the use of an iliac bone graft in all patients. There were 22 one-level, 7 two-level and 1 three-level fusions. Overall 19 patients (73%) had good to excellent results according to the criteria of Simmons and Segil. Six patients (23%) had a fair outcome and one (3.8%) a poor result. More good to excellent results (85.7%) were seen after two-level fusions than after one-level fusions (61.9%). Patients presenting with pain radiation to the upper limbs had a more favorable outcome. Better results also were found in patients with pain onset after cervical spine trauma than those without. However, due to the limited number of patients in this group, differences did not reach statistically significant levels. Reported postoperative results in the literature in similar patient groups without preoperative evaluation of the symptomatic level by discography show a good to excellent outcome in a less favorable range of 35%–46% disc degeneration [13, 30] in asymptomatic subjects was demonstrated. Therefore, it is not surprising that MRI, a more sensitive diagnostic tool for morphologic changes within vertebral discs, reveals high levels of changes in disc pattern. These findings are, however, not necessarily the cause of symptoms and may lead to overtreatment [2, 27]. Discography as a diagnostic tool and an indicator for surgical treatment has been reported on several times especially in the North American literature [22, 25, 31, 35]. The value of contrast discography in differentiating symptomatic degenerated discs from asymtomatic ones has been debated and the subject remains controversial [17, 24, 26].

In this study the postoperative results were evaluated of segmental cervical spine fusions in patients in whom cervical discography had been used to diagnose “discogenic pain syndrome” and to indicate the symptomatic levels to be fused.