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Factors influencing manometric pressure during pressure-controlled discography.

Authors
Shin, DA; Kim, SH; Han, IB; Rhim, SC; Kim, HI
Citation
Spine, 34(22):E790-E793, 2009
Journal Title
Spine
ISSN
0362-24361528-1159
Abstract
STUDY DESIGN: In vitro laboratory study.



OBJECTIVE: The aim of this study was to evaluate the effects of injection speed, contrast viscosity, and needle profile on manometric pressures during discography.



SUMMARY OF BACKGROUND DATA: As the degree of the response in a provocation test depends on the intensity of the stimulus, the precise measurement of intradiscal pressure during discography is crucial. Although manometric pressure measurement is safe and easy, manometric pressures may be affected by potential confounding factors, including injection speed, contrast viscosity, and needle profile.



METHODS: Pressure-controlled discography was performed using an automated pressure-controlled discography system in a total of 60 intervertebral discs in 2 porcine cadavers. Dynamic pressures were measured while changing the following parameters: injection speed (0.01 mL/s vs. 0.08 mL/s), media viscosity (Visipaque vs. normal saline), needle diameter (18G vs. 22G), and needle length (7 inch vs. 3.5 inch). The unit change in manometric pressure per fractional change in injected volume (dP/dV) was used for statistical analysis.



RESULTS: The mean dP/dV increased from 137.9 +/- 11.3 at 0.08 mL/s to 160.3 +/- 12.5 at 0.01 mL/s. Visipaque injection resulted in a higher mean dP/dV than the normal saline injection (160.3 +/- 12.5 vs. 97.8 +/- 34.1). A 7.5 inch needle had a higher mean dP/dV than a 3.5 inch needle (137.9 +/- 11.3 vs. 92.5 +/- 48.6). The mean dP/dV of the 22G needle was higher than the 18G needle (137.9 +/- 11.3 vs. 84.7 +/- 28.3).



CONCLUSION: High injection speed, high viscosity, small diameter, and a long needle increase the dynamic pressure. To minimize the differences among examiners, we recommend standardization of injection speed, the viscosity of the injected material, and the diameter and length of the needle.
MeSH terms
AnimalsBiomechanics/physiologyColoring Agents/diagnostic useCompressive Strength/physiologyContrast Media/diagnostic useElasticity/physiologyEquipment DesignFibrocartilage/pathologyFibrocartilage/physiopathologyInjections, Spinal/instrumentationInjections, Spinal/methodsIntervertebral Disk/pathologyIntervertebral Disk/physiopathology*Intervertebral Disk Displacement/diagnosis*Intervertebral Disk Displacement/physiopathology*Manometry/methodsNeedlesPain Measurement/methods*Predictive Value of TestsPressure/adverse effects*Sensitivity and SpecificitySus scrofaTransducers, PressureWeight-Bearing/physiology
DOI
10.1097/BRS.0b013e3181ba2a8d
PMID
19829241
Appears in Collections:
Journal Papers > School of Medicine / Graduate School of Medicine > Neurosurgery
AJOU Authors
김, 상현
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