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September 28, 1964

Pockets of Enthusiasm

JAMA. 1964;189(13):1033. doi:10.1001/jama.1964.03070130053029

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To the Editor:—  Dr. Holt's communication, following closely on the heels of two other contributions questioning the diagnostic value of this procedure, should serve to dampen localized pockets of enthusiastic uncritical use of this diagnostic tool. One cannot describe the abnormal until one determines the range of normal, and Dr. Holt has shown the wide distribution and age range of what was unjustifiably considered abnormal. Since cervical discography is invariably followed by anterior discectomy and interbody fusion, the procedure lacks even the dignity of surgical confirmation. An occasional posterior surgical approach has shown how unreliable the discographic findings are. Despite the relatively high incidence of neckshoulder pain, the cases reported to date have shown a disproportionately high frequency of medicolegal involvement, suggesting a patient selectivity that lends the entire problem a verdant hue. One can't help wondering whether this has colored the thinking of some of those involved.

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