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Association between findings of provocative discography and vertebral endplate signal changes as seen on MRI
H S Sandhu1, L P Sanchez-Caso, H K Parvataneni
1Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, New York 10021, USA. sandhuh@hss.edu
Abstract:
Provocative discography is a controversial diagnostic tool for pathologic discs. Modic has identified vertebral endplate signal changes on magnetic resonance imaging (MRI) that are thought to signify advanced discogenic degeneration. These two distinct diagnostic tools are examined to determine if there is association between them. Fifty-three consecutive patients who underwent both investigations were retrospectively reviewed. In discs that had negative T1 MRI findings, 28.2% of patients had concordant pain and 17.3% had discordant pain. In discs with positive T1 MRI findings, 34.8% of patients had concordant pain and 17.4% had discordant pain. 79.5% and 74.4% of levels with patient concordant pain on discography had no endplate changes on T1- and T2 weighted MR images, respectively (compared with 84.5% and 81.7%, respectively, for levels with no patient pain on discography). Our data showed no significant relationship between these distinct diagnostic tools. Further investigation of their relative roles in this application is recommended.
Insights
Provocative discography and Modic changes on MRI are diagnostic tools for disc degeneration. This study found no significant relationship between these methods for diagnosing pathologic discs.
Area of Science:
- Orthopedics
- Radiology
- Pain Management
Background:
- Provocative discography is a controversial diagnostic tool for pathologic discs.
- Modic changes on MRI indicate advanced discogenic degeneration.
Purpose of the Study:
- To examine the association between provocative discography and Modic changes on MRI.
- To determine if these distinct diagnostic tools correlate in identifying discogenic pain.
Main Methods:
- Retrospective review of 53 consecutive patients who underwent both provocative discography and MRI.
- Analysis of T1 and T2 weighted MRI findings, specifically Modic changes, in relation to discographic pain provocation.
Main Results:
- No significant relationship was found between provocative discography findings and Modic changes on MRI.
- A high percentage of patients with concordant pain on discography showed no endplate changes on MRI (79.5% T1, 74.4% T2).
- Conversely, many levels without pain on discography also showed no endplate changes on MRI (84.5% T1, 81.7% T2).
Conclusions:
- The study suggests no significant association between provocative discography and Modic changes on MRI.
- Further research is recommended to clarify the distinct roles of these diagnostic tools in evaluating discogenic conditions.