Discography

Written by Staff | 27 July 2011

The spinal disc has long been implicated as a cause of back pain based on clinical and other research¹, and an estimated 40% of chronic lumbosacral spinal pain may be caused by intervertebral (spinal) discs².

Discography is a minimally invasive, relatively painless diagnostic procedure used when clinical evaluation suggests a patient’s back or Neck Pain is originating from a disc and other sources of pain have been ruled out³. It allows the doctor to visualize a disc suspected of causing acute or chronic back pain.

A discography study generally takes approximately 30-60 minutes. A long needle is inserted into the center of the intervertebral disc after the area is anesthetized. Real time X-ray (fluoroscopy) is used in order to ensure proper placement of the larger needle and assess the internal structure of the discs. A special dye is injected into the disc, making the disc visible on x-ray film. This is called a discogram. In addition, pressure created by the injection is used to determine whether the disc being tested is causing the patient’s pain. Based upon the results of the patient’s discogram, the physician will suggest what he or she believes to be the optimal course of treatment.

As with all medical procedures, patients who undergo discography are subject to the risk of developing complications. However, discography is considered a low-risk diagnostic intervention and reported complications have been minimal.

At the current level of understanding, discography is regarded as the best tool to evaluate disc-related pain⁴, and systematic reviews back the efficacy of discography as a diagnostic tool^5,6. In general, diagnostic studies such as MRI and CT scans show anatomical dysfunctions whereas discography is able to pinpoint specific structures producing the pain and provide unique information about the pain source and the morphology of a spinal disc^7,8. In addition, discography carries a very low false-positive rate⁹.

References

1. Buenaventura RM, Shah RV, Patel V, Benyamin R, & Singh V. (2007). Systematic review of discography as a diagnostic test for spinal pain: an update. Pain Physician., 10(1), 147-64.
2. Kallewaard JW, Terheggen MA, Groen GJ, Sluijter ME, Derby R, Kapural L, Mekhail N, & van Kleef M. (2010). 15. Discogenic low back pain. Pain Pract., 10(6), 560-79.
3. Stout A. (2010). Discography. Phys Med Rehabil Clin N Am., 21(4), 859-67.
4. Buenaventura RM, Shah RV, Patel V, Benyamin R, & Singh V. (2007). Systematic review of discography as a diagnostic test for spinal pain: an update. Pain Physician., 10(1), 147-64.
5. Manchikanti L, Glaser SE, Wolfer L, Derby R, & Cohen SP. (2009). Systematic review of lumbar discography as a diagnostic test for chronic low back pain. Pain Physician., 12(3), 541-59.
6. Buenaventura RM, Shah RV, Patel V, Benyamin R, & Singh V. (2007). Systematic review of discography as a diagnostic test for spinal pain: an update. Pain Physician., 10(1), 147-64.
7. Zhou Y, & Abdi S. (2006). Diagnosis and minimally invasive treatment of lumbar discogenic pain--a review of the literature. Clin J Pain., 22(5), 468-81.
8. Brightbill TC, Pile N, Eichelberger RP, & Whitman M Jr. (1994). Normal magnetic resonance imaging and abnormal discography in lumbar disc disruption. Spine (Phila Pa 1976)., 19(9), 1075-7.
9. Wolfer LR, Derby R, Lee JE, & Lee SH. (2008). Systematic review of lumbar provocation discography in asymptomatic subjects with a meta-analysis of false-positive rates.Pain Physician., 11(4), 513-38.