Discography: Technique

There are two approaches to the lumbar disc, posterior (intra-pedicular) and lateral (extra-pedicular).

April, C. Diagnostic Disc Injection. Chapter 21, The Adult Spine, Principles and Practice, 1991, Raven Press.

The posterior approach necessitates a dural puncture, and therefore should be avoided. Disc puncture is typically performed with a 22 or 25 gauge needle (insert figures). There is some evidence that using an introducer needle can reduce the risk of infection, although this is not a universal practice.

Fraser, et al. Discitis after discography. JBJS (Br) 1987 69B:1;26-35.

While rarely encountered, a variety of complications are possible with discography, including neural injury, bleeding, and intradural leakage of injected substances.

Guyer, et al. Contemporary Concepts in Spine Care- Lumbar Discography. Spine 1995 20:18; 2048-59.

Trosier. An Accurate Method for Lumbar Disc Puncture Using a Single Channel Intensifier. Spine 1990 15:3;222-8.

MacMillan, et al. Routes and Incidence of Communication of Lumbar Discs with Surrounding Neural Structures. Spine 1991 16:2;167-171.

There have been case reports of disc herniations resulting from discography (1,2). While canine studies have had conflicting results on the potential for disc injury during discography, the weight of evidence in humans suggests that this is not a significant problem.

(1) Grubb, SA. Herniated disc after discography. Spine 1987.

(2) Gill, K. Herniated disc after automated percutaneous discectomy. Spine 1994.

Johnson, R. Does Discography Injure Normal Discs? An Analysis of Repeat Discograms. Spine 1989 14:4;424-6.

Kahanovitz, et al. The Effect of Discography on the Canine Intervertebral Disc. Spine 1984:26-7.

Inufusa, et al. Effect of annular puncture on the adolescent canine intervertebral disc. Abstract, NASS annual meeting, 1997.

The most significant risk associated with discography is infection. The rate of discitis reported in the literature is as high as 1.3% per disc, and serious morbidity has resulted.

Fraser, et al. Discitis after discography. JBJS (Br) 1987 69B:1;26-35.

Guyer, et al. Discitis after Discography. Spine 1988 13:12;1352-4.

Junila, et al. Epidural Abscess after Lumbar Discography- A Case Report. Spine 1997 22:18;2191-3.

However, practice audits at centers performing a large volume of discography have demonstrated infection rates as low as 0 out of 10,000 (R. Derby, personal communication). There is experimental evidence that prophylactic antibiotics, both intravenous and intradiscal, can prevent discitis. As a result, many practitioners routinely administer prophylactic antibiotics, particularly to high risk patients such as diabetics.

Fraser, et al. Iatrogenic Discitis: the Role of Intravenous Antibiotics in Prevention and Treatment. Spine 1989 14:9;1025-31.

Lang, et al. Penetration of Ceftriaxome into the Intervertebral Disc. JBJS 1994 76A:5;689-91.

Osti, et al. Discitis after Discography- The role of prophylactic antibiotics. JBJS (Br) 1990 72B:271-4.

Jamrich, et al. Antibiotic Penetration Into the Adult Human Nucleus Pulposus. Abstract, NASS annual meeting, 1997.