Ultrasound-guided cervical analgesic discography vs. conventional fluoroscopy-guided provocative discography for cervical discogenic pain: a propensity score-matched analysis

Objective Cervical discogenic pain (CDP) requires accurate diagnostic localization prior to surgical intervention. This study aimed to evaluate the efficacy of ultrasound (US)-guided anesthetic discography compared to the conventional fluoroscopy (FL)-guided provocative discography in diagnosing CDP before fusion surgery. Methods Medical records from 292 patients were reviewed. Patients were categorized into two cohorts: US cohort, undergoing US-guided cervical analgesic discography with FL confirmation; and FL cohort, receiving FL-guided cervical provocative discography. A 1:1 propensity-score matching was performed for controlling selection bias. Primary endpoint was the accuracy rate of good to excellent outcomes at 3 months post-surgery. Secondary outcomes included procedural variables, numeric rating scales (NRS) pain scores, Oswestry Disability Index (ODI) and adverse events. Results The accuracy rate in the US cohort was 918%, which fell within the predetermined range of 85% to 95% and was significantly higher than the 78.7% observed in the FL cohort, (difference=13.1%, 95%CI: 5.0% to 21.0%; p = 0.018). The US cohort exhibited a lower median NRS pain score than the FL cohort at both 1-week (adjusted p < 0.001) and 3-month (adjusted p < 0.001) follow-ups. Furthermore, the US cohort also had a lower mean ODI score than that the FL cohort at both 1-week (adjusted p < 0.001) and 3-month (adjusted p = 0.002) follow-ups. US-guided procedures were associated with fewer number of needle attempts before contrast administration, shorter procedure time, fewer fluoroscopic shots/lower radiation dosages and a reduced incidence of inadvertent vascular puncture (all p < 0.05). No serious adverse events were observed in either cohort. Conclusions US-guided cervical analgesic discography provided better predictive accuracy in diagnosing CDP prior to surgery than FL-guided provocative discography. Given the short-term advantages over 3 months of follow-up, US-guided analgesic discography might serve as an alternative to the conventional method for making surgical decision; further validation in larger prospective cohorts with longer follow-up was warranted.