Discography Summary: Section 1

If a patient is being considered for surgical fusion for axial pain, pressure controlled discography is indicated to determine whether they have chemically sensitized discs, in which case Derby’s data suggests a high likelihood of success with an anterior interbody fusion.

Derby, et al. The ability of pressure controlled discography to predict surgical and non-surgical outcome. Spine, in press.

At present it is not clear what the appropriate treatment for disc falling into either the mechanically sensitive or indeterminate categories. Preliminary information suggests that intertransverse fusion alone may be effective for mechanically sensitive discs.

Derby, et al. The ability of pressure controlled discography to predict surgical and non-surgical outcome. Spine, in press.

Future research should focus on validating the disc classification system proposed by Derby, and in particular further studying the predictive value of the mechanically sensitive and indeterminate categories.

Although not the primary focus of discography, it is important to assess the radiologic findings. The images should be reviewed to confirm that the needle was placed into the nucleus and that the subsequent dye injection fills the nucleus. Annular injections, injections into the space between the annulus and the nuclear cavity, and venous uptake are all possible, and may invalidate the results.

Quinell, et al. An Investigation of Artefacts of Lumbar Discography. British Journal of Radiology. September 1980 53:633;831-9.

Schellhas. Venous Opacification During Discography: Therapeutic Implications. ISIS annual meeting, 1996.

A variety of classification schemes have been developed to describe annular pathology as visualized by discography.

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

Maezwa, et al. Pain Provocation at Lumbar Discography as Analyzed by Computed Tomography/Discography. Spine 1992 17:11;1309-15.

Ninomiya, et al. Pathoanatomy of Lumbar Disc Herniation as Demonstrated by Computed Tomography/Discography. Spine 1992 17:11;1316-22.

Videman, et al. The Value of the Axial View in Assessing Discograms. Spine 12:3;299-304.

McCutcheon, et al. CT Scanning of Lumbar Discography. Spine 1986 11:3;257-9.

Quinell, et al. The Use of In Vivo Lumbar Discography to Assess the Clinical Significance of the Position of the Intercristal Line. Spine 1983 8:3;305-7.