Discography Interpretation and Techniques in the Lumbar Spine
The authors provide an indepth analysis of discography, a provocative diagnostic tool to determine the origin of low-back pain. Injecting the intervertebral disc with radiopaque dye provides physicians with several useful pieces of information. First, the modality provides radiographic evaluation of the integrity of the nucleus pulposus and anular rings to determine tears or other lesions that could be creating low-back pain. Second, and very important, is its measure of disc nociception. A normal disc should not cause pain when injected; however, a disc that is physiologically compromised can mimic the pain previously experienced by a patient. The authors review the indications, technique, and interpretation of discography to allow a better understanding of when to use this diagnostic test and what to do with the results.
Lumbar discography is an invasive diagnostic procedure that involves, under fluoroscopic guidance, the puncturing of a disc for the instillation of iodinated contrast into the nucleus pulposus. This procedure provides direct radiographic information concerning the nuclear morphological features and integrity of the vertebral endplates and anulus. The measured contrast injection allows determination of intradiscal pressures. Measurements of the opening pressures and pressure endpoints, where no further contrast can be injected, as well as the measurements of the associated volumes of contrast injected in the disc, can be used to demonstrate the integrity of the inner and outer anuli. The resulting changes in the volume and pressure produce direct stimulation of the disc. A patient's response to this stimulation is a measure of disc nociception. Therefore, the purpose of this procedure is not only to define the anatomical architecture of the internal disc but to determine whether a particular disc is painful. This provocative response to injection can be useful in identifying the pain generator and assist in the assessment of patients with severe disabling back pain syndromes.
Abstract and Introduction
Abstract
The authors provide an indepth analysis of discography, a provocative diagnostic tool to determine the origin of low-back pain. Injecting the intervertebral disc with radiopaque dye provides physicians with several useful pieces of information. First, the modality provides radiographic evaluation of the integrity of the nucleus pulposus and anular rings to determine tears or other lesions that could be creating low-back pain. Second, and very important, is its measure of disc nociception. A normal disc should not cause pain when injected; however, a disc that is physiologically compromised can mimic the pain previously experienced by a patient. The authors review the indications, technique, and interpretation of discography to allow a better understanding of when to use this diagnostic test and what to do with the results.
Introduction
Lumbar discography is an invasive diagnostic procedure that involves, under fluoroscopic guidance, the puncturing of a disc for the instillation of iodinated contrast into the nucleus pulposus. This procedure provides direct radiographic information concerning the nuclear morphological features and integrity of the vertebral endplates and anulus. The measured contrast injection allows determination of intradiscal pressures. Measurements of the opening pressures and pressure endpoints, where no further contrast can be injected, as well as the measurements of the associated volumes of contrast injected in the disc, can be used to demonstrate the integrity of the inner and outer anuli. The resulting changes in the volume and pressure produce direct stimulation of the disc. A patient's response to this stimulation is a measure of disc nociception. Therefore, the purpose of this procedure is not only to define the anatomical architecture of the internal disc but to determine whether a particular disc is painful. This provocative response to injection can be useful in identifying the pain generator and assist in the assessment of patients with severe disabling back pain syndromes.
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