Past Issue - October 2008 - Vol 11 Issue 5 Index | Previous | Next | 
2008;11;631-642. Systematic Review of Thoracic Discography as a Diagnostic Test for Chronic Spinal Pain
Systematic Review
Vijay Singh, MD, Laxmaiah Manchikanti, MD, Rinoo V. Shah, MD, Elmer E. Dunbar, MD, and Scott E. Glaser, MD
 

BACKGROUND: Even though the prevalence of thoracic pain has been reported to be 15% of the general population and up to 22% of the population in interventional pain management settings, the role of thoracic discs as a cause of chronic thoracic and extrathoracic pain has not been well researched. The intervertebral discs, zygapophysial or facet joints, and other structures including the costovertebral and costotransverse joints have been identified as a source of thoracic pain.
 
OBJECTIVE: To systematically assess the quality of clinical studies evaluating the diagnostic accuracy of provocation thoracic discography.
 
STUDY DESIGN: A systematic review of provocation thoracic discography.
 
METHODS: A systematic review of the literature was performed to assess the diagnostic accuracy of thoracic discography with respect to chronic, function limiting, thoracic or extrathoracic pain.
 
Studies meeting the Agency for Healthcare Research and Quality (AHRQ) methodologic quality criteria with scores of 50 or higher were included for the assessment of the level of evidence. Level of evidence was based on the United States Preventive Services Task Force (USPSTF) criteria for the assessment of accuracy of diagnostic studies. Based on the level of evidence, recommendations were made according to Guyatt et alís criteria.
 
RESULTS: The clinical value of thoracic provocation discography is limited (Level II-3) with 2C/weak recommendation derived from low quality or very low quality evidence indicating that other alternatives may be equally reasonable.
 
CONCLUSION: Based on the available evidence for this systematic review, thoracic provocation discography is provided with a weak recommendation for the diagnosis of discogenic pain in the thoracic spine, if conservative management has failed. This is qualified by the need to appropriately evaluate and diagnose other causes of chronic thoracic pain including pain originating from thoracic facet joints.

 

   
 
Author Information
>> Manuscript Guidelines
Advertising
>> Rates
>> Ad format requirements

Quick Search in
PubMed
CrossRef
Pain Physcian
Authors
Scott E. Glaser
Rinoo V. Shah
Elmer E. Dunbar
Laxmaiah Manchikanti
Vijay Singh


Keywords
Thoracic pain
chest wall pain
intervertebral disc
thoracic intervertebral disc
facet joint
thoracic disc herniation
discogenic pain
lumbar provocation discography
cervical provocation discography
thoracic provocation discography