Table 2.
Diagnostic values of index tests for discogenic pain in two or more studies
| Author | Pain free control disc | Index cut off /details | Sensitivity | Specificity | +LR | −LR |
|---|---|---|---|---|---|---|
| MRI- High intensity zone (HIZ) | ||||||
| April et al. [2] | Yes | Not stated | 70 (56–82) | 88 (77–95) | 5.9 (2.8–12.5) | 0.34(0.22–0.51) |
| Ito et al. [18] | No | Not stated | 52 (31–73) | 89 (80–95) | 4.8 (2.3–10.2) | 0.54(0.35–0.82) |
| Lam et al. [21] | No | Not stated | 81 (71–88) | 78 (65–88) | 3.7 (2.2–6.0) | 0.25(0.16–0.38) |
| Lim et al. [28] | No | Not stated | 56 (38–72) | 70 (57–80) | 1.8 (1.1–2.9) | 0.64(0.43–0.96) |
| Ricketson et al. [40] | Yes | Not stated | 12 (4–27) | 92 (80–98) | 1.5 (0.4–5.6) | 0.96(0.83–1.11) |
| Schellhas et al. [43] | Yes | Not stated | 97 (91–100) | 83 (73–90) | 5.7 (3.5–9.3) | 0.03(0.01–0.11) |
| Smith et al. [50] | No | Not stated | 27 (13–45) | 90 (83–95) | 2.6 (1.2–5.6) | 0.82(0.66–1.02) |
| Weishaupt et al. [56] | No | Not stated | 28 (16–42) | 85 (74–92) | 1.8 (0.8–3.7 | 0.86(0.70–1.04) |
| Yoshida et al. [59] | No | Not stated/T2 scan | 92 (69–99) | 71 (55–84) | 3.2 (1.9–5.3) | 0.12 (0.03–0.55) |
| Not stated/ T1 scan | 70 42–90) | 74 (56–88) | 2.7 (1.4–5.3) | 0.40 (0.18–0.90) | ||
| Saifuddin et al. [42] | No | Not stated | 27 (18–37) | 94 (86–98) | 4.8 (1.7–14.2) | 0.77 (0.67–0.89) |
| MRI- Disc degeneration (reduced signal intensity) | ||||||
| Braithwaite et al. [5] | No | Not stated | 86 (78–93) | 78 (66–88) | 4.0 (2.5–6.5) | 0.18 (0.10–0.30) |
| Carragee et al. [6] | Yes | ≥ Grade 1 | 92 (69–99) | 43 (30–56) | 1.6 (1.2–2.1) | 0.20 (0.04–0.93) |
| ≥ Grade 2 | 81 (55–95) | 62 (48–74) | 2.1 (1.4–3.1) | 0.32 (0.12–0.82) | ||
| ≥ Grade 3 | 47 (24–72) | 89 (78–96) | 4.3 (1.8–10.2 | 0.59 (0.38–0.93) | ||
| Horton et al. [17] | No | Dark & speckled | 93 (72–100) | 43 (27–59) | 1.6 (1.2–2.2) | 0.18 (0.04–0.85) |
| Dark only | 38 (17–62) | 87 (72–95) | 2.8 (1.1–7.3) | 0.72 (0.50–1.04) | ||
| Ito et al. [18] | No | Moderate & severe | 94 (76–100) | 46 (35–58) | 1.7 (1.4–2.2) | 0.14 (0.03–0.65) |
| Severe | 69 (47–86) | 88 (79–94) | 5.7 (3.0–11.0) | 0.36 (0.20–0.65) | ||
| Lim et al. [28] | No | Grade IV and V | 87 (72 96) | 52 (40–65) | 1.8 (1.4–2.4) | 0.25 (0.10–0.60) |
| Parker et al. [37] | No | Dark disc | 89 (69–98) | 68 (41–88) | 2.8 (1.4–5.6) | 0.16 (0.05–0.52) |
| Weishaupt et al. [56] | No | Slight, moderate & severe | 97 (88–100) | 59 (46–70) | 2.3 (1.8–3.1) | 0.05 (0.01–0.26) |
| Osti et al. [36] | No | Decreased & absent | 69 (52–82) | 64 (52–75) | 1.9 (1.3–2.7) | 0.49 (0.30–0.80) |
| Absent | 24 (12–40) | 91 (83–97) | 2.8 (1.1–7.0) | 0.83 (0.69–1.00) | ||
| Endplate/Modic changes | ||||||
| Braithwaite et al. [5] | No | Grade 1–3 | 24 (15–34) | 96 (88–99) | 6.0 (1.7–21.2) | 0.80 (0.70–0.90) |
| Grade 1 | 5 (2–13) | 99 (93–100) | 7.4 (0.4–131) | 0.95 (0.90–1.00) | ||
| Grade 2 | 18 (10–27) | 96 (88–99) | 4.4 (1.2–16.1) | 0.86 (0.77–0.95) | ||
| Grade 3 | 4 (1–10) | 99 (93–100) | 4.7 (2.5–89.3) | 0.97 (0.93–1.02) | ||
| Ito et al. [18] | No | All grades | 23 (8–45) | 94 (87–98) | 4.0 (1.3–12.8) | 0.82 (0.65–1.02) |
| Lim et al. [28] | No | Not stated | 10 (3–25) | 82 (70 90) | 0.6 (0.2–1.7) | 1.1(0.94–1.3) |
| Weishaupt et al. [56] | No | Grade 1 all | 30 (17–34) | 96 (89–99) | 8.2 (2.2–29.7) | 0.73 (0.61–0.88) |
| Grade 1 (moderate & severe) | 24 (13–38) | 99 (93–100) | 32.4 (2.0–536.7) | 0.77 (0.66–0.90) | ||
| Grade 2 all | 19 (10–33) | 98 (91–100) | 8.9 (1.7–48.0) | 0.82 (0.72–0.95) | ||
| Grade 2 (moderate & severe) | 15 (6–29) | 99 (93–100) | 21.1 (1.2–361.2) | 0.85 (0.76–0.96) | ||
| Grade 1&2 (all) | 48 (34–63) | 95 (87–99) | 9.5 (3.3–27.3) | 0.55 (0.42–0.72) | ||
| Grade 1&2 (moderate & severe) | 38 (24–53) | 99 (93–100) | 52.1 (3.2–844.1) | 0.63 (0.50–0.78) | ||
| Kokkonen et al. [20] | No | ≥ Grade 1 | 41 (25–58) | 63 (50–75) | 1.1 (0.7–1.8) | 0.93 (0.68–1.29) |
| ≥ Grade 2 | 22 (10–39) | 78 (67–88) | 1.0 (0.5–2.2) | 0.99 (0.8–1.23) | ||
| ≥ Grade 3 | 4 (0–16) | 98 (91–100) | 1.8 (0.2–16.4) | 0.98 (0.91–1.06) | ||
| MRI- Annular disruption | ||||||
| Vanharanta et al. [54] | No | Not stated | 94 (87–98) | 55 (46–63) | 2.1 (1.7–2.5) | 0.10 (0.04–0.26) |
| Yrjama et al. [63] | No | Grade 3 | 65 (43–83) | 64 (24–94) | 1.8 (0.64–5.1) | 0.55 (0.25–1.19) |
| MRI - Narrowing | ||||||
| Ito et al. [18] | No | Moderate & severe | 85 (65–96) | 69 (58–79) | 2.8 (1.9–3.9) | 0.21 (0.08–0.56) |
| Severe | 31 (14–53) | 97 (90–100) | 9.9 (2.5–38.3) | 0.71 (0.54–0.93) | ||
| Lim et al. [28] | No | Not stated | 30 (16–48) | 82 (70–91) | 1.7 (0.8–3.5) | 0.85 (0.67–1.09) |
| Clinical examination - Centralisation | ||||||
| Donelson et al. [12] | Yes | Not stated* | 64 (46–79) | 70 (50–86) | 2.1 (1.1–3.9) | 0.52 (0.32–0.86) |
| Young et al. [60] | Yes | Not stated* | 47 (22–73) | 95 (62–100) | 9.4 (0.6–146.9) | 0.56 (0.35–0.91) |
| Laslett et al. [25] | Yes | Partial & full exam* | 38 (26–51) | 89 (69–98) | 3.5 (1.0–11.7) | 0.70 (0.55–0.89) |
| Full examination* | 40 (27–55) | 92 (69–99) | 4.9 (1.0–23.3 | 0.65 (0.50–0.84) | ||
| Laslett et al. [26] | Yes | Complete & partial centralisers* | 35 (22–51) | 86 (62–98) | 2.6 (0.8–8.7) | 0.75 (0.56–0.99) |
| Complete centralisers* | 23 (12–38) | 97 (77–100) | 8.2 (0.5–133.0) | 0.78 (0.67–0.95) | ||
| Pooled results | ||||||
| Spinous process bony vibration | ||||||
| Vanharantaet al. [54] | No | Not stated* | 71 (57–82) | 60 (39–80) | 1.8 (1.1–3.0) | 0.49 (0.29–0.82) |
| Not stated (per disc) | 63 (51–73) | 77 (69–84) | 2.7 (1.9–3.9) | 0.48 (0.36–0.65) | ||
| Yrjama et al. [63] | No | Not stated* | 60 (39–80) | 64 (24–94) | 1.7 (0.60–4.8) | 0.62 (0.29–1.29 |
| Yrjama et al. [62] | No | Not stated* | 65 (44 82) | 58 (28–84) | 1.5 (0.8–3.1) | 0.61 (0.31–1.22) |
| Yrjama et al. [61] | No | Not stated* | 71 (54–84) | 63 (38–83) | 1.9 (1.0–3.4) | 0.47 (0.26–0.85) |
| Not stated (per disc) | 79 (57–94) | 82 (53–97) | 4.5 (1.4–14.0 | 0.25 (0.11–0.59) | ||
* Analysis at the level of the patient, all others at the level of the disc. +LR, positive likelihood ratio; −LR, negative likelihood ratio; MRI, magnetic resonance imaging