The Spine Journal, Volume 3, Issue 3, Supplement 1, May-June 2003, Pages 11-27
Richard D. Guyer, Donna D. Ohnmeiss, Alexander Vaccaro
Lumbar discography remains a controversial diagnostic procedure. There are concerns about its safety and clinical value, although many support its use in specific applications. The purpose of the review is to update the North American Spine Society position statement published in 1994 that addressed criticisms of lumbar discography, to identify indications for summary of background data.
A comprehensive review of the literature dealing with lumbar discography was conducted. Articles dealing with lumbar discography were reviewed and are summarized in this report.
Most of the recent literature supports the use of discography in selected patients. Although not to be taken lightly, many of the serious complications and high complication rates reported before 1970 have decreased since then because of improvement in injection technique, imaging and contrast materials.
Most of the current literature supports the use of discography in select situations. Indications for discography include, but are not limited to: (1) Further evaluation of demonstrably abnormal discs to help assess the extent of abnormality or correlation of the abnormality with the clinical symptoms. Such symptoms may include recurrent pain from a previously operated disc andlateral disc herniation. (2) Patients with persistent, severe symptoms in whom other diagnostic tests have failed to reveal clear confirmation of a suspected disc as the source of pain. (3) Assessment of patients who have failed to respond to surgical intervention to determine if there is painful pseudarthrosis or a symptomatic disc in a posteriorly fused segment and to help evaluate possible recurrent disc herniation. (4) Assessment of discs before fusion to determine if the discs within the proposed fusion segment are symptomatic and to determine if discs adjacent to this segment are normal. (5) Assessment of candidates for minimally invasive surgical intervention to confirm a contained disc herniation or to investigate dye distribution pattern before chemonucleolysis or percutaneous procedures. Lumbar discography should be performed by those well experienced with the procedure and in sterile conditions with a double-needle technique and fluoroscopic imaging for proper needle placement. Information assessed and recorded should include the volume of contrast injected, pain response, with particular emphasis on its locations and similarity to clinical symptoms, and the pattern of dye distribution. Frequently, discography is followed by axial computed tomography scanning to obtain more information about the condition of the disc.