Pre-operative Discography: Appropriate Indications and Clinical Interpretation

Hirsch [11] and Lindblom [16] first described the use of discography for the clinical evaluation of intervertebral disc pathology in 1948. It was initially utilized to help determine the level of a possible disc herniation with patients presenting with sciatica. Over the past 60 years, discography has evolved into a technique almost exclusively used for the diagnosis of discogenic pain or pain emanating from internal disruption of the disc including tears in the anulus. In spite of a large body of literature on discography, the purpose of this technique remains extremely controversial. One reason for controversy reflects the fact that conflicting reports on the sensitivity, specificity and predictive value of discography have been published. In addition, discography has more recently become an important part of the decision making process for some spine surgeons in determining which patients would benefit from lumbar arthrodesis for treatment of unrelenting low back pain. Because the results of surgery for lumbar discogenic pain have been disappointing, controversy exists as to the validity and positive predictive importance of this invasive procedure of discography.