{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T15:26:41Z","timestamp":1782314801474,"version":"3.54.5"},"reference-count":13,"publisher":"Oxford University Press (OUP)","issue":"11","license":[{"start":{"date-parts":[[2020,4,28]],"date-time":"2020-04-28T00:00:00Z","timestamp":1588032000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,11,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Summary of Background Data<\/jats:title><jats:p>The literature on cervical provocation discography (C-PD) is sparse. A \u201cStartle Response\u201d during C-PD is a known phenomenon that might be mistaken as an indicator of discogenic pain at the provoked disc level, but this has not been quantitatively described.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objectives<\/jats:title><jats:p>To determine the incidence of the Startle Response and its concordance\/discordance with true-positive C-PD in patients referred for surgical planning or evaluation after ruling out other axial pain generators.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Retrospective cohort study of consecutive patients who received C-PD at an outpatient spine center. The primary outcome was the rate of discordance of the Startle Response with true-positive C-PD according to the operational criteria of the Spine Intervention Society (SIS) guidelines.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>One hundred five discs were provoked in 36 individuals (19 female, mean age [SD] = 45.7 [10.9] years). C-PD was performed at a median of three levels (range = 1\u20135) with C4\/5 (N\u2009=\u200930), C5\/6 (N\u2009=\u200930), and C6\/7 (N\u2009=\u200931) the most commonly evaluated. Twenty-six of 36 patients reported responses consistent with true-positive C-PD. A Startle Response was observed in 14 patients (39%, 95% confidence interval [CI] = 23\u201357%), and 22 of 105 (21%, 95% CI = 14\u201330%) provoked discs. Of the 14 patients who exhibited a Startle Response, four had negative C-PD results (29%, 95% CI = 8\u201358%). As assessed per disc, C-PD results were positive in 12 of the 22 (55%, 95% CI = 32\u201376%) provoked discs that generated a Startle Response.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The present data demonstrate high discordance, 45% (95% CI = 24\u201368%), between the Startle Response and true-positive C-PD. Clinicians should be aware of this phenomenon and take care to distinguish it from a true-positive response during C-PD, as defined by the SIS guidelines. Misinterpretation of the Startle Response as a positive C-PD result may lead to inappropriate future care decisions in a substantial proportion of patients.<\/jats:p><\/jats:sec>","DOI":"10.1093\/pm\/pnaa099","type":"journal-article","created":{"date-parts":[[2020,3,16]],"date-time":"2020-03-16T20:34:07Z","timestamp":1584390847000},"page":"2738-2742","source":"Crossref","is-referenced-by-count":2,"title":["Prevalence and Discordance of the \u201cStartle Response\u201d with True Discogenic Pain According to Spine Intervention Society Guidelines for Provocation Discography: A Cohort Study"],"prefix":"10.1093","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7756-3763","authenticated-orcid":false,"given":"Fred","family":"DeFrancesch","sequence":"first","affiliation":[{"name":"Interventional Spine Specialists, Metairie, Louisiana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beau P","family":"Sperry","sequence":"additional","affiliation":[{"name":"Division of Physical Medicine and Rehabilitation, University of Utah, Salt Lake City, Utah, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles N","family":"Aprill","sequence":"additional","affiliation":[{"name":"Interventional Spine Specialists, Metairie, Louisiana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Douglas","family":"Choe","sequence":"additional","affiliation":[{"name":"Interventional Spine Specialists, Metairie, Louisiana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zachary L","family":"McCormick","sequence":"additional","affiliation":[{"name":"Division of Physical Medicine and Rehabilitation, University of Utah, Salt Lake City, Utah, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2020,4,28]]},"reference":[{"issue":"1","key":"2020112415465201600_pnaa099-B1","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1093\/pm\/pnx034","article-title":"Diagnostic value, prognostic value, and safety of provocation discography","volume":"19","author":"McCormick","year":"2018","journal-title":"Pain Med"},{"issue":"11","key":"2020112415465201600_pnaa099-B2","doi-asserted-by":"crossref","first-page":"1373","DOI":"10.1097\/00007632-200006010-00009","article-title":"The rates of false-positive lumbar discography in select patients without low back symptoms","volume":"25","author":"Carragee","year":"2000","journal-title":"Spine (Phila Pa 1976)"},{"issue":"4","key":"2020112415465201600_pnaa099-B3","doi-asserted-by":"crossref","first-page":"513","DOI":"10.36076\/ppj.2008\/11\/513","article-title":"Systematic review of lumbar provocation discography in asymptomatic subjects with a meta-analysis of false-positive rates","volume":"11","author":"Wolfer","year":"2008","journal-title":"Pain Physician"},{"key":"2020112415465201600_pnaa099-B4","first-page":"721","author":"Derby","year":"2008"},{"key":"2020112415465201600_pnaa099-B5","volume-title":"Practice Guidelines for Spinal Diagnostic and Treatment Procedures","author":"Bogduk","year":"2013","edition":"2nd ed."},{"issue":"2","key":"2020112415465201600_pnaa099-B6","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1016\/0304-3959(93)90211-7","article-title":"On the nature of neck pain, discography and cervical zygapophysial joint blocks","volume":"54","author":"Bogduk","year":"1993","journal-title":"Pain"},{"issue":"3","key":"2020112415465201600_pnaa099-B7","doi-asserted-by":"crossref","first-page":"300","DOI":"10.1097\/00007632-199602010-00009","article-title":"Cervical discogenic pain. Prospective correlation of magnetic resonance imaging and discography in asymptomatic subjects and pain sufferers","volume":"21","author":"Schellhas","year":"1996","journal-title":"Spine (Phila Pa 1976)"},{"issue":"24","key":"2020112415465201600_pnaa099-B8","doi-asserted-by":"crossref","first-page":"2819","DOI":"10.1097\/00007632-199412150-00015","article-title":"A correlation of cervical magnetic resonance imaging and discography\/computed tomographic discograms","volume":"19","author":"Parfenchuck","year":"1994","journal-title":"Spine (Phila Pa 1976)"},{"issue":"19","key":"2020112415465201600_pnaa099-B9","doi-asserted-by":"crossref","first-page":"2140","DOI":"10.1097\/01.brs.0000141172.99530.e0","article-title":"Value of magnetic resonance imaging and discography in determining the level of cervical discectomy and fusion","volume":"29","author":"Zheng","year":"2004","journal-title":"Spine (Phila Pa 1976)"},{"issue":"4","key":"2020112415465201600_pnaa099-B10","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1007\/BF00441832","article-title":"Cervical discography in discogenic pain syndrome and its predictive value for cervical fusion","volume":"113","author":"Siebenrock","year":"1994","journal-title":"Arch Orthop Trauma Surg"},{"issue":"7","key":"2020112415465201600_pnaa099-B11","first-page":"395","article-title":"Diagnostic value of cervical discography in the management of cervical discogenic pain","volume":"64","author":"Motimaya","year":"2000","journal-title":"Conn Med"},{"issue":"2","key":"2020112415465201600_pnaa099-B12","doi-asserted-by":"crossref","first-page":"272","DOI":"10.1302\/0301-620X.63B2.7217155","article-title":"Localisation of the level of symptomatic cervical disc degeneration","volume":"63-B","author":"Kikuchi","year":"1981","journal-title":"J Bone Joint Surg Br"},{"issue":"21","key":"2020112415465201600_pnaa099-B13","doi-asserted-by":"crossref","first-page":"2224","DOI":"10.1097\/00007632-199911010-00009","article-title":"Anterior discectomy and fusion for the management of neck pain","volume":"24","author":"Palit","year":"1999","journal-title":"Spine (Phila Pa 1976)"}],"container-title":["Pain Medicine"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/painmedicine\/article-pdf\/21\/11\/2738\/34484876\/pnaa099.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/painmedicine\/article-pdf\/21\/11\/2738\/34484876\/pnaa099.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,10,18]],"date-time":"2022-10-18T22:39:29Z","timestamp":1666132769000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/painmedicine\/article\/21\/11\/2738\/5826478"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,4,28]]},"references-count":13,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2020,4,28]]},"published-print":{"date-parts":[[2020,11,1]]}},"URL":"https:\/\/doi.org\/10.1093\/pm\/pnaa099","relation":{},"ISSN":["1526-2375","1526-4637"],"issn-type":[{"value":"1526-2375","type":"print"},{"value":"1526-4637","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2020,11]]},"published":{"date-parts":[[2020,4,28]]}}}