The role of provocative discography in minimally invasive selective endoscopic discectomy

A discogenic etiology is being widely accepted as a primary source of chronic low-back pain. Even though increasing information is available on the pathophysiology of the degenerated disc, the present MR techniques are still not capable of pin-pointing the source of this pain. In other words, with a non-invasive MR1 study we can still not define which disc is painful and what are the characteristics of discogenic pain from an imaging perspective. Discography remains therefore the only functional test that can delimit both morphologically and by provocation which discs are involved in the patents clinical picture. In combination with endoscopic procedures it helps tailor treatments. We consider that this diagnostic tool should be used routinely and performed by the surgeon himself as part of a screening-therapy protocol in spine surgery. We present our considerations regarding this diagnostic-screening method based on our clinical and surgical experience in patients who have been evaluated and have undergone selective endoscopic disscetomy after the screening.