The potential impact of various diagnostic strategies in cases of chronic pain syndromes associated with lumbar spine degeneration
Authors Bokov A, Perlmutter O, Aleynik A, Rasteryaeva M, Mlyavykh S
Received 11 January 2013
Accepted for publication 27 February 2013
Published 17 April 2013 Volume 2013:6 Pages 289—296
Checked for plagiarism Yes
Review by Single-blind
Peer reviewer comments 2
Andrey Bokov, Olga Perlmutter, Alexander Aleynik, Marina Rasteryaeva, Sergey Mlyavykh
Scientific Research Institute of Traumatology and Orthopedics, Nizhniy Novgorod, Russian Federation
Purpose: To study the possible effects of various diagnostic strategies and the relative contribution of various structures in order to determine the optimal diagnostic strategy in treating patients with noncompressive pain syndromes.
Study design: Prospective, nonrandomized cohort study of 83 consecutive patients with noncompressive pain syndromes resistant to repeated courses of conservative treatment. The follow-up period was 18 months.
Results: Nucleoplasty was effective in cases of discogenic pain; the consequences related to false positive results of the discography were significant. The most specific criterion was 80% pain relief after facet joint blocks, whereas 50% pain relief and any subjective pain relief were not associated with a significant increase in the success rate. A considerable rate of false negative results was associated with 80% pain relief, whereas 50% pain relief after facet joint blocks showed the optimal ratio of sensitivity and specificity. Facet joint pain was detected in 50.6% of cases (95% confidence interval 44.1%–66.3%), discogenic pain in 16.9% cases (95% confidence interval 9.5%–26.7%), and sacroiliac joint pain in 7.2% cases (95% confidence interval 2.7%–15%). It was impossible to differentiate the main source of pain in 25.3% of cases.
Conclusion: It is rational to adjust the diagnostic algorithm to the probability of detecting a particular pain source and, in doing so, reduce the number of invasive diagnostic measures to evaluate a pain source. False positive results of diagnostic measures can negatively affect the overall efficacy of a particular technology; therefore, all reasons for the failure should be studied in order to reach an unbiased conclusion. In choosing diagnostic criteria, not only should the success rate of a particular technology be taken into consideration but also the rate of false negative results. Acceptable diagnostic criteria should be based on a rational balance of sensitivity and specificity.
Keywords: diagnostic strategy, lumbar spine, noncompressive pain, sensitivity, specificity
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