Cervical discography in discogenic pain syndrome and its predictive value for cervical fusion

We have reviewed 27 patients who underwent fusion of a total of 39 cervical levels for discogenic pain syndrome. All patients were diagnosed by positive discography defined as provocation of their characteristic pain on a Adams type 3-5 contrast distribution pattern. The mean age of the patients was 46.4 years and the follow-up averaged 16.2 months (range 9-42 months). Fusion was performed through a ventral approach with the use of an iliac bone graft in all patients. There were 22 one-level, 7 two-level and 1 three-level fusions. Overall 19 patients (73%) had good to excellent results according to the criteria of Simmons and Segil. Six patients (23%) had a fair outcome and one (3.8%) a poor result. More good to excellent results (85.7%) were seen after two-level fusions than after one-level fusions (61.9%). Patients presenting with pain radiation to the upper limbs had a more favorable outcome. Better results also were found in patients with pain onset after cervical spine trauma than those without. However, due to the limited number of patients in this group, differences did not reach statistically significant levels. Reported postoperative results in the literature in similar patient groups without preoperative evaluation of the symptomatic level by discography show a good to excellent outcome in a less favorable range of 35%-46%.