Guidelines for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 6: magnetic resonance imaging and discography for patient selection for lumbar fusion

Standards. There is insufficient evidence to recommend a treatment standard. Guidelines. 1) It is recommended that MR imaging be used as a diagnostic test instead of discography for the initial evaluation of patients with chronic low-back pain. 2) It is recommended that MR imaging-documented disc spaces that appear to be normal not be considered for treatment as a source of low-back pain. 3) It is recommended that lumbar discography not be used as a stand-alone test on which treatment decisions are based for patients with low-back pain. 4) If discography is performed as a diagnostic tool to identify the source of a patient's low-back pain, it is recommended that both a concordant pain response and morphological abnormalities be present at the pathological level prior to initiating any treatment directed at that level. Options. 1) It is recommended that discography be reserved for use in patients with equivocal MR imaging findings, especially at levels adjacent to clearly pathological levels. 2) It is recommended that patients in whom discography is positive but in whom MR imaging evidence of disc degeneration is absent not be considered candidates for operative intervention.