RESULTS The results of this review confirm and help quantify the significant differences that existed in the terminology and all the areas of diagnosis and treatment of presumed discogenic pain .
Our findings show that suspected discogenic pain , despite its extensive affirmation in the literature and enormous re sources regularly devoted to it , currently lacks clear diagnostic criteria and uniform treatment or terminology
BACKGROUND CONTEXT Pain innate to intervertebral disc , often referred to as discogenic pain , is suspected by some authors to be the major source of chronic low back and neck pain .
Current management of suspected discogenic pain lacks st and ardized diagnosis , treatment , and terminology .
PURPOSE In an attempt to determine whether patterns existed that may facilitate st and ardization of care , we sought to analyze the terminologies used and the various modes of diagnosis and treatment of suspected discogenic pain .
A prospective, randomised controlled trial of femoral ring allograft versus a titanium cage in circumferential lumbar spinal fusion with minimum 2-year clinical results
The literature reports on the safety and efficacy of titanium cages ( TCs ) with additional posterior fixation for anterior lumbar interbody fusion . However , these papers are limited to prospect i ve cohort studies . The introduction of TCs for spinal fusion has result ed in increased costs , without evidence of superiority over the established practice . There are currently no prospect i ve controlled trials comparing TCs to femoral ring allografts ( FRAs ) for circumferential fusion in the literature . In this prospect i ve , r and omised controlled trial , our objective was to compare the clinical outcome following the use of FRA ( current practice ) to the use of TC in circumferential lumbar spinal fusion . Full ethical committee approval and institutional research and development departmental approval were obtained . Power calculations estimated a total of 80 patients ( 40 in each arm ) would be required to detect clinical ly relevant differences in functional outcome . Eighty-three patients were recruited for the study fulfilling strict entry requirements ( > 6 months chronic discogenic low back pain , failure of conservative treatment , one- or two-level discographically proven discogenic low back pain ) . The patients completed the Oswestry Disability Index ( ODI ) , Visual Analogue Score ( VAS ) for back and leg pain and the Short-Form 36 ( SF-36 ) preoperatively and also postoperatively at 6 , 12 and 24 months , respectively . The results were available for all the 83 patients with a mean follow-up of 28 months ( range 24–75 months ) . Five patients were excluded on the basis of technical infringements ( unable to insert TC in four patients and FRA in one patient due to the narrowing of the disc space ) . From the remaining 78 patients r and omised , 37 received the FRA and 41 received the TC . Posterior stabilisation was achieved with translaminar or pedicle screws . Baseline demographic data ( age , sex , smoking history , number of operated levels and preoperative outcome measures ) showed no statistical difference between groups ( p<0.05 ) other than for the vitality domain of the SF-36 . For patients who received the FRA , mean VAS ( back pain ) improved by 2.0 points ( p<0.01 ) , mean ODI improved by 15 points ( p=<0.01 ) and mean SF-36 scores improved by > 11 points in all domains ( p<0.03 ) except that of general health and emotional role . For patients who received the  TC  , mean VAS improved by 1.1 points ( p=0.004 ) , mean ODI improved by 6 points ( p=0.01 ) and SF-36 improved significantly in only two of the eight domains ( bodily pain and physical function ) . Revision procedures and complications were similar in both groups . In conclusion , this prospect i ve , r and omised controlled clinical trial shows the use of FRA in circumferential lumbar fusion to be associated with superior clinical outcomes when compared to those observed following the use of TCs . The use of TCs for circumferential lumbar spinal fusion is not justified on the basis of inferior clinical outcome and the tenfold increase in cost
RESULTS The results of this review confirm and help quantify the significant differences that existed in the terminology and all the areas of diagnosis and treatment of presumed discogenic pain .
Our findings show that suspected discogenic pain , despite its extensive affirmation in the literature and enormous re sources regularly devoted to it , currently lacks clear diagnostic criteria and uniform treatment or terminology
BACKGROUND CONTEXT Pain innate to intervertebral disc , often referred to as discogenic pain , is suspected by some authors to be the major source of chronic low back and neck pain .
Current management of suspected discogenic pain lacks st and ardized diagnosis , treatment , and terminology .
PURPOSE In an attempt to determine whether patterns existed that may facilitate st and ardization of care , we sought to analyze the terminologies used and the various modes of diagnosis and treatment of suspected discogenic pain .