Excerpt from Discography

Synonyms, Key Words, and Related Terms: back pain, discogenic pain, discogram, disk herniation, disk injection, herniated disk, internal disk disruption, intervertebral disk, neck pain, provocative discography, spine pain

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Discography was first described in 1948 as an investigative technique for herniated nucleus pulposus. Since that time, new imaging techniques that are more appropriate for this diagnosis have been developed. Discography is currently used to determine whether the disk is the source of pain in patients with predominantly axial back or neck pain.

During discography, contrast medium is injected into the disk and the patient's response to the injection is noted; provocation of pain that is similar to the patient's existing back or neck pain suggests that the disk might the source of the pain. Computed tomography (CT) is usually performed after discography to assess anatomical changes in the disk and to demonstrate intradiscal clefts and radial tears.

Early studies suggested that discography had a low specificity, but more recent studies have failed to induce pain in asymptomatic controls, suggesting that discography has utility in identifying patients with discogenic pain. Pain reproduction during discography in symptomatic individuals is variable, with a lower incidence of pain reproduction in patients with disk degeneration than in those with posterior tears of the anulus fibrosus or significant disk bulges.

Controlled clinical trials of discography are lacking, and a standard against which to compare is elusive. When comparing outcomes of fusion procedures, lumbar discography is sensitive but lacks specificity (see Images 1-3).

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