炎性腰痛诊断标准.pdfVIP

SPINE Volume 31, Number 18, pp 2115–2123 ©2006, Lippincott Williams Wilkins, Inc. A Gold Standard Evaluation of the “Discogenic Pain” Diagnosis as Determined by Provocative Discography Eugene J. Carragee, MD, Todd Lincoln, MD, Vik Singh Parmar, MD, and Todd Alamin, MD Approximately 300,000 spinal fusions are performed in Study Design. This is a prospective study of the valid- the United States each year.1 The most controversial sub- ity of a positive test result in provocative lumbar discog- group of these spinal fusions is that performed for sup- raphy for the diagnosis of “discogenic pain.” Objective. To investigate the hypothesis that provoc- posed “discogenic pain,” which is primarily diagnosed ative discography by strict criteria accurately identifies a by provocative discography. In this test, the nucleus of a low back pain illness due to a primary disc lesion. disc suspected of causing a patient’s severe low back pain Summary and Background Data. According to the (LBP) illness is injected. If this provocation demonstrates Sackett and Haynes criteria for establishing diagnostic test validity, no test without a gold standard external anular disruption and reproduces the patient’s usual standard can be meaningfully applied. Provocative dis- LBP, this is usually considered a positive test, confirming cography as a test for determining “discogenic pain” has, that the disc per se is the cause of the p