Lumbar discography: a tool for understanding spinal pain.

The procedure is diagnostic in nature and is performed by a provider knowledgeable in spinal anatomy as well as in radiological imaging and equipment. Discography is the only means of directly assessing whether a patient’s disc is the cause of back or neck pain. It is a more sensitive test for internal disc disruption than magnetic resonance imaging (MRI). Disc abnormalities may be identified on computed tomography (CT) or MRI studies, but the procedure of discography is the only method available that can link the patient’s pain response directly to a disc abnormality. Discography is performed using fluoroscopy. A positive pain response means that when the disc is injected with a low volume of contrast, the patient reports concordant pain (pain that is the same as the pain the patient normally experiences). Often, a postdiscogram CT scan is performed. The CT scan allows for a more thorough visualization, assessment, and identification of disc abnormalities. It is important to note that many people suffer from asymptomatic lumbosacral disc degeneration. The most important aspect of discography lies in the patient’s clinical responses and not in radiographic assessment of the disc anatomy. Simply stated, the goal of discography is to identify whether pressurization of a disc produces pain that is concordant, or pain in the same distribution or area reported prior to the procedure. Patients may have pain that is more intense than normal with this procedure, but if it is in the normal distribution it is still considered concordant. A discordant response occurs when the patient reports pain in an area that is not his or her normal pain pattern. All patient responses during the procedure are carefully recorded.