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Lumbar discography: an update.

Mark W Anderson1

  • 1Department of Radiology, University of Virginia, PO Box 800170, Charlottesville, VA 22908, USA.

Seminars in Roentgenology
|February 24, 2004
PubMed
Summary
This summary is machine-generated.

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Discogenic pain, often from internal disc degeneration, can be accurately diagnosed with discography. Following specific procedural guidelines, like using control levels and observing patient cues, maximizes diagnostic accuracy for low back pain.

Area of Science:

  • Spine diagnostics
  • Pain management
  • Radiology

Background:

  • Discogenic pain commonly affects the low back, buttocks, and hips, stemming from internal disc degeneration.
  • Progressive annular breakdown may stimulate pain fibers, causing discomfort.
  • While MRI shows structural abnormalities, discography offers physiological insights into pain generation.

Purpose of the Study:

  • To highlight the importance of discography in diagnosing discogenic pain.
  • To provide practical strategies for enhancing the accuracy of the discography procedure.
  • To address the ongoing controversy surrounding discography's reliability.

Main Methods:

  • Injecting a 'normal' intervertebral disc as a control level.
  • Monitoring for factors increasing false-positive rates, such as abnormal pain maps or prior surgery.

Related Experiment Videos

  • Employing patient distraction techniques (conversation, music) and careful observation of verbal/nonverbal pain cues.
  • Re-injecting contrast for equivocal results to confirm pain concordance.

    • Main Results:

    • Discography is the only diagnostic test providing physiological information on a disc's role in pain.
    • Adherence to specific procedural guidelines can significantly improve diagnostic accuracy.
    • Careful assessment of patient pain response is crucial, requiring technical skill and awareness of potential pitfalls.

    Conclusions:

    • Discography remains a vital tool for diagnosing discogenic pain, despite ongoing debate.
    • Implementing recommended techniques can mitigate false-positive results and enhance diagnostic confidence.
    • Radiologists must prioritize patient pain assessment alongside technical execution for accurate lumbar discography.