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Adherence to Discography Guidelines Is Lackluster

Many specialties perform procedure; compliance ranges from poor to fair

THURSDAY, Aug. 12 (HealthDay News) -- National compliance with professional guidelines for discography, a controversial procedure to diagnose disc damage contributing to back pain, ranges from poor to fair, according to research published in the August issue of the Journal of Spinal Disorders & Techniques.

David Kim, M.D., and Robert Wadley, M.D., of the Henry Ford Medical Center in Detroit, surveyed 500 members of the International Spine Intervention Society (ISIS) about the procedure. They sought to discover how it is being carried out and by which specialties, and also to measure adherence to ISIS guidelines.

The researchers note that the 173 respondents included specialists in anesthesiology (57.8 percent), physical medicine/rehabilitation (30.6 percent), radiology (9.2 percent), and other (2.3 percent). Adherence to guidelines for use of preoperative antibiotics and intradiscal antibiotics was fair (83.81 and 84.97 percent, respectively), but use of double needle technique was poor (64.16 percent). The post-procedure use of antibiotics, for which there is no guideline, was 9.82 percent. Adherence to guidelines affecting diagnostic accuracy was generally poor, ranging from 48.55 percent (for inserting the discography needle on the opposite side of symptoms) to 78.61 percent (for injecting a control disc first). Adherence to guidelines was not improved for higher patient volumes.

"Discography appears to be performed by several different specialties with specialty variability in technique. The overall compliance with ISIS guidelines is fair to poor with the specialty rank order of compliance greatest to least as follows: anesthesiology, physical medicine/rehabilitation, and radiology," the authors write.

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