Practical PAIN MANAGEMENT, January/February 2007 ©2007 PPM Communications, Inc. Reprinted with permission. Diagnostic Provocation Discographic Injections Lumbar provocation discography remains a controversial diagnostic technique; and even more so with cervical/ thoracic discography. To appreciate the historical controversy surrounding discography is to understand that its inception was a tenuo...

STUDY DESIGN Magnetic resonance discography using gadolinium as an intradiscal contrast agent was investigated in a prospective study. OBJECTIVE To evaluate the utility of magnetic resonance discography using gadolinium as an intradiscal contrast agent, as compared with the current standard of computed tomographic discography using intradiscal iodinated contrast agent. SUMMARY OF BACKGROUND...

STUDY DESIGN  Retrospective cohort study. OBJECTIVES  To find out (1) if magnetic resonance imaging (MRI) findings associated with positive discography in patients with lumbar discogenic pain are caused by degenerative disc disease (DDD). (2) If clinical risk factors associated with positive discography in patients with lumbar discogenic pain are caused by DDD. METHODS  Thirty-three discogr...

The technique that developed into discography was first described by Lindblom (1) when he used the term diagnostic disc puncture. Hirsch (2) used the procedure to identify painful discs in patients with sciatica and lumbar pain. Lindblom (1) did further work using the injection of contrast media to visualize radial tears in the annulus, expanding the diagnostic information from intervertebral d...

Discography is an exquisitely sensitive but not specific diagnostic test for the diagnosis of discogenic low-back pain. The restriction of the definition of a positive discographic study to one that elicits concordant pain from a morphologically abnormal disc improves the definition's accuracy. Fusion surgery based on discography alone, however, is not reliably associated with clinical success....

BACKGROUND The intervertebral disc has been implicated as an etiology of chronic spine pain based on clinical, basic science, and epidemiological research. There is currently no way to determine with absolute certainty whether or not the disc is a spinal pain generator. At our current level of understanding, discography is thought of as the best tool to evaluate disc-related pain. STUDY DESIG...

OBJECTIVE To investigate the correlation among age, disc morphology, positive discography, and prognosis in patients with chronic low back pain. METHODS A total of 183 intervertebral discs in 72 patients with chronic low back pain were studied. Discography was performed using a pressure-controlled manometric technique. The pain reaction during discography at each level was recorded as follows...

The aim of this study was to analyze the correlation between high-intensity zone (HIZ) on magnetic resonance imaging (MRI) of a lumbar disc and positive pain response assessed by discography for the diagnosis and treatment of discogenic low back pain (LBP). Thirty-seven patients aged 21 to 59 years with chronic LBP but without any neurological symptoms or lumbar disc herniation who underwent MR...

BACKGROUND To assess whether unilateral L2 infiltration with local anesthetic can be used to identify patients who will have negative discograms and thus eliminate the need for the discogram. Discogenic low-back pain is considered to have afferent pathways in the sinuvertebral nerves, mainly originating from the ventral rami of the spinal nerves. There is evidence that pain arising from the low...

STUDY DESIGN Prospective, match-cohort study of disc degeneration progression over 10 years with and without baseline discography. Objectives. To compare progression of common degenerative findings between lumbar discs injected 10 years earlier with those same disc levels in matched subjects not exposed to discography. Summary of Background Data. Experimental disc puncture in animal and in vivo...