Factors influencing manometric pressure during pressure-controlled discography

DongAh Shin, Sang Hyun Kim, In Bo Han, Seung Chul Rhim, Hyoung Ihl Kim

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Study Design. In vitro laboratory study. Objective. The aim of this study was to evaluate the effects of injection speed, contrast viscosity, and needle profile on manometric pressures during discography. Summary of Background Data. As the degree of the response in a provocation test depends on the intensity of the stimulus, the precise measurement of intradiscal pressure during discography is crucial. Although manometric pressure measurement is safe and easy, manometric pressures may be affected by potential confounding factors, including injection speed, contrast viscosity, and needle profile. Methods. Pressure-controlled discography was performed using an automated pressure-controlled discography system in a total of 60 intervertebral discs in 2 porcine cadavers. Dynamic pressures were measured while changing the following parameters: injection speed (0.01 mL/s vs. 0.08 mL/s), media viscosity (Visipaque vs. normal saline), needle diameter (18G vs. 22G), and needle length (7 inch vs. 3.5 inch). The unit change in manometric pressure per fractional change in injected volume (dP/dV) was used for statistical analysis. Results. The mean dP/dV increased from 137.9 ± 11.3 at 0.08 mL/s to 160.3 ± 12.5 at 0.01 mL/s. Visipaque injection resulted in a higher mean dP/dV than the normal saline injection (160.3 ± 12.5 vs. 97.8 ± 34.1). A 7.5 inch needle had a higher mean dP/dV than a 3.5 inch needle (137.9 ± 11.3 vs. 92.5 ± 48.6). The mean dP/dV of the 22G needle was higher than the 18G needle (137.9 ± 11.3 vs. 84.7 ± 28.3). Conclusion. High injection speed, high viscosity, small diameter, and a long needle increase the dynamic pressure. To minimize the differences among examiners, we recommend standardization of injection speed, the viscosity of the injected material, and the diameter and length of the needle.

Original languageEnglish
JournalSpine
Volume34
Issue number22
DOIs
Publication statusPublished - 2009 Oct 15

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Needles
Pressure
Viscosity
Injections
Intervertebral Disc
Cadaver
Swine

All Science Journal Classification (ASJC) codes

  • Orthopedics and Sports Medicine
  • Clinical Neurology

Cite this

Shin, DongAh ; Kim, Sang Hyun ; Han, In Bo ; Rhim, Seung Chul ; Kim, Hyoung Ihl. / Factors influencing manometric pressure during pressure-controlled discography. In: Spine. 2009 ; Vol. 34, No. 22.
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Factors influencing manometric pressure during pressure-controlled discography. / Shin, DongAh; Kim, Sang Hyun; Han, In Bo; Rhim, Seung Chul; Kim, Hyoung Ihl.

In: Spine, Vol. 34, No. 22, 15.10.2009.

Research output: Contribution to journalArticle

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AU - Shin, DongAh

AU - Kim, Sang Hyun

AU - Han, In Bo

AU - Rhim, Seung Chul

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N2 - Study Design. In vitro laboratory study. Objective. The aim of this study was to evaluate the effects of injection speed, contrast viscosity, and needle profile on manometric pressures during discography. Summary of Background Data. As the degree of the response in a provocation test depends on the intensity of the stimulus, the precise measurement of intradiscal pressure during discography is crucial. Although manometric pressure measurement is safe and easy, manometric pressures may be affected by potential confounding factors, including injection speed, contrast viscosity, and needle profile. Methods. Pressure-controlled discography was performed using an automated pressure-controlled discography system in a total of 60 intervertebral discs in 2 porcine cadavers. Dynamic pressures were measured while changing the following parameters: injection speed (0.01 mL/s vs. 0.08 mL/s), media viscosity (Visipaque vs. normal saline), needle diameter (18G vs. 22G), and needle length (7 inch vs. 3.5 inch). The unit change in manometric pressure per fractional change in injected volume (dP/dV) was used for statistical analysis. Results. The mean dP/dV increased from 137.9 ± 11.3 at 0.08 mL/s to 160.3 ± 12.5 at 0.01 mL/s. Visipaque injection resulted in a higher mean dP/dV than the normal saline injection (160.3 ± 12.5 vs. 97.8 ± 34.1). A 7.5 inch needle had a higher mean dP/dV than a 3.5 inch needle (137.9 ± 11.3 vs. 92.5 ± 48.6). The mean dP/dV of the 22G needle was higher than the 18G needle (137.9 ± 11.3 vs. 84.7 ± 28.3). Conclusion. High injection speed, high viscosity, small diameter, and a long needle increase the dynamic pressure. To minimize the differences among examiners, we recommend standardization of injection speed, the viscosity of the injected material, and the diameter and length of the needle.

AB - Study Design. In vitro laboratory study. Objective. The aim of this study was to evaluate the effects of injection speed, contrast viscosity, and needle profile on manometric pressures during discography. Summary of Background Data. As the degree of the response in a provocation test depends on the intensity of the stimulus, the precise measurement of intradiscal pressure during discography is crucial. Although manometric pressure measurement is safe and easy, manometric pressures may be affected by potential confounding factors, including injection speed, contrast viscosity, and needle profile. Methods. Pressure-controlled discography was performed using an automated pressure-controlled discography system in a total of 60 intervertebral discs in 2 porcine cadavers. Dynamic pressures were measured while changing the following parameters: injection speed (0.01 mL/s vs. 0.08 mL/s), media viscosity (Visipaque vs. normal saline), needle diameter (18G vs. 22G), and needle length (7 inch vs. 3.5 inch). The unit change in manometric pressure per fractional change in injected volume (dP/dV) was used for statistical analysis. Results. The mean dP/dV increased from 137.9 ± 11.3 at 0.08 mL/s to 160.3 ± 12.5 at 0.01 mL/s. Visipaque injection resulted in a higher mean dP/dV than the normal saline injection (160.3 ± 12.5 vs. 97.8 ± 34.1). A 7.5 inch needle had a higher mean dP/dV than a 3.5 inch needle (137.9 ± 11.3 vs. 92.5 ± 48.6). The mean dP/dV of the 22G needle was higher than the 18G needle (137.9 ± 11.3 vs. 84.7 ± 28.3). Conclusion. High injection speed, high viscosity, small diameter, and a long needle increase the dynamic pressure. To minimize the differences among examiners, we recommend standardization of injection speed, the viscosity of the injected material, and the diameter and length of the needle.

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