Lumbar Discography

Introduction

The intervertebral disc can be injected with contrast, local anesthetic, or other substances. Although observing the effect of a local anesthetic injection on pain and function (analgesic discography) can potentially provide useful information, the clinical utility of this has not been well defined. The effect of an applied mechanical and/or chemical stimulus on pain (provocative discography) does have demonstrated clinical utility, however, and will be the focus of this review.

In addition to provoking pain that can be compared to the patient’s clinical symptoms, injecting contrast into the disc may demonstrate pathology that is not otherwise revealed on conventional imaging studies. Prior to the advent of sophisticated imaging studies such as CT/MRI, discography was often used primarily as a radiologic imaging study to complement myelography.

Lindblom, K. Diagnostic puncture of intervertebral disks in sciatica. Acta Orthop Scand 1948 17:231-8.

Several studies have confirmed the accuracy of discography as a radiologic test in demonstrating both disc herniations and disc degeneration.

Brodsky, et al . Lumbar Discography- Its value in diagnosis and Treatment of Lumbar Disc Lesions. Spine 1979 4:2;110-120.

Bernard. Using Computed Tomography/Discography and Enhanced Magnetic Resonance Imaging to Distinguish Between Scar Tissue and Recurrent Lumbar Disc Herniation. Spine 1994 19:24;2826-32.

Jackson, et al. Foraminal and Extraforaminal Lumbar Disc Herniation: Diagnosis and Treatment. Spine 1987 12:6;577-85.

Gunzberg, et al. A Cadaveric Study Comparing Discography, Magnetic Resonance Imaging, Histology, and Mechanical Behavior of the Human Lumbar Disc. Spine 1992 17:4;417-423.

Simmons, et al. Awake Discography. A Comparison Study with Magnetic Resonance Imaging. Spine 1991 16:6;S216-21.

Zucherman, et al. Normal Magnetic Resonance Imaging with Abnormal Discography. Spine 1988 13:12;1355-9.

Milette, et al. Spine 1990 15:6;525-33. 50% of abnormal CT-discography discs are normal on CT.

With the advent of MRI scanning, and in particular the use of gadolinium enhancement in evaluating postoperative patients, the utility of discography purely as a radiologic study is diminished. However, both cadaver and clinical studies have demonstrated that discography is more sensitive than MRI in detecting disc degeneration, particularly when post-discography CT scanning is added.

Gunzberg, et al. A Cadaveric Study Comparing Discography, Magnetic Resonance Imaging, Histology, and Mechanical Behavior of the Human Lumbar Disc. Spine 1992 17:4;417-423.

Simmons, et al. Awake Discography. A Comparison Study with Magnetic Resonance Imaging. Spine 1991 16:6;S216-21.

Zucherman, et al. Normal Magnetic Resonance Imaging with Abnormal Discography. Spine 1988 13:12;1355-9.

Sachs, et al. Dallas Discogram Description. A New Classification of CT/Discography in Low Back Disorders. Spine 1987 12:3;287-94.

Bernard. Lumbar Discography Followed by Computed Tomography- Refining the Diagnosis of Low Back Pain. Spine 1990 15:7; 690-707.

The purpose of discography is to determine whether the intervertebral disc is a source of clinical symptoms. While interpretation of the radiologic images obtained at the time of discography is important, in contemporary practice discography is primarily a provocative clinical test, rather than a radiologic imaging procedure.