The results of this review demonstrate that tests do exist that change the probability of the disc or SIJ ( but not the facet joint ) as the source of low back pain .
Clinical practice guidelines state that the tissue source of low back pain can not be specified in the majority of patients .
However , there has been no systematic review of the accuracy of diagnostic tests used to identify the source of low back pain .
The aim of this systematic review was therefore to determine the diagnostic accuracy of tests available to clinicians to identify the disc , facet joint or sacroiliac joint ( SIJ ) as the source of low back pain .
The Outcome of Posterolateral Fusion in Highly Selected Patients With Discogenic Low Back Pain
Study Design A prospect i ve analysis of the clinical outcome of a consecutive series of patients treated with posterior lumbar arthrodesis .  Preoperative data were collected retrospectively by chart review . Objectives To measure by independent review the clinical outcome of posterolateral intertransverse fusion as a treatment for discogenic low back pain in a highly selected group of patients . Summary of Background Data Although numerous studies have reported on the surgical management of degenerative disc disease , they have been difficult to interpret because they lack patient‐oriented outcome assessment and objective pain measurement criteria , independent review , and include patients with diagnoses other than degenerative disc disease . Methods Between 1991 and February 1993 all patients seen by a single surgeon , evaluated with magnetic resonance imaging and discography , and treated with posterolateral lumbar fusion were review ed by independent investigation . Outcome was assessed in the areas of radiographic fusion , pain , function , and patient satisfaction . Results Twenty‐three patients ( 12 women , 11 men ; 100 % follow‐up an average of 47 months after surgery [ range , 24–84 months ] ) met the inclusion criteria . Overall , 39 % had a good or excellent result , 13 % fair , and 48 % poor . Nine of 10 patients receiving worker 's compensation had a poor result ; four of five patients with radiographic pseudarthrosis  had a poor result . Statistically significant improvement in the visual analogue scale was noted in the good and excellent group ( P = 0.0001 ) and the fair group ( P = 0.002 ) with no change in the poor group . Patients out of work more than 3 months before surgery tended to have poor results . Overall , 56 % of patients were extremely satisfied with the result of their surgery . Conclusion Posterolateral intertransverse fusion can be used to successfully manage chronic discogenic back pain . However , patient selection remains a challenge , and successful outcome appears to be limited in the subset of patients receiving worker 's compensation and those chronically disabled . Prospect i ve and r and omized study with objective pain criteria , independent review , and patient‐oriented outcome is recommended
The results of this review demonstrate that tests do exist that change the probability of the disc or SIJ ( but not the facet joint ) as the source of low back pain .
Clinical practice guidelines state that the tissue source of low back pain can not be specified in the majority of patients .
However , there has been no systematic review of the accuracy of diagnostic tests used to identify the source of low back pain .
The aim of this systematic review was therefore to determine the diagnostic accuracy of tests available to clinicians to identify the disc , facet joint or sacroiliac joint ( SIJ ) as the source of low back pain .