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Prospective evaluation of contrast-enhanced MR imaging after uncomplicated lumbar discography
John A Carrino1, Todd C Swathwood, William B Morrison
1Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Outpatient Center, Johns Hopkins University School of Medicine, 601 N. Caroline Street, Room 5165, Baltimore, MD 21287, USA. jcarrin2@jhmi.edu
Objective:
Postdiscography infection is an uncommon complication. Magnetic resonance (MR) imaging is often the modality of choice for evaluating spinal infection. Discography entails disc access and fluid injection that could alter the baseline MR imaging appearance of the spine and be confounded for infection. Our purpose was to describe the MR imaging findings of the lumbar spine subsequent to uncomplicated discography and to determine if this may mimic infection.
Design And Patients:
In a prospective cohort study of eight adults (age 22-64 years, mean 45 years) with 22 intradiscal injections, all subjects underwent routine unenhanced and contrast-enhanced MR imaging during the 2-3 week interval postdiscography. A subset of four returned for additional MR imaging during the 4-8 week interval postdiscography. MR images were reviewed for intradiscal, endplate, marrow, and epidural findings and then compared with prediscography examinations. Infection was excluded by clinical documentation.
Results:
Postdiscography MR imaging showed that almost all levels were similar to baseline prediscography examinations. No levels developed new vertebral marrow edema, fluid-like intradiscal signal, endplate irregularity, or epidural abnormality. Two subjects simulated potential discitis, but these findings were unchanged from prediscography and were related to prior surgery.
Conclusions:
Uncomplicated lumbar spine discography does not cause MR imaging changes that simulate discitis.
Insights
Uncomplicated lumbar spine discography does not alter magnetic resonance (MR) imaging to mimic infection. Postdiscography MR imaging findings remain similar to baseline, excluding simulated discitis.
Area of Science:
- Radiology
- Spinal Imaging
- Infectious Disease
Background:
- Postdiscography infection is a rare complication.
- Magnetic resonance (MR) imaging is crucial for diagnosing spinal infections.
- Discography may alter baseline MR imaging, potentially mimicking infection.
Purpose of the Study:
- To describe MR imaging findings after uncomplicated lumbar spine discography.
- To determine if these findings can be mistaken for infection.
Main Methods:
- Prospective cohort study of 8 adults undergoing 22 intradiscal injections.
- Routine unenhanced and contrast-enhanced MR imaging 2-3 weeks postdiscography.
- Follow-up MR imaging for a subset at 4-8 weeks, compared to pre-discography scans.
Main Results:
- Postdiscography MR imaging largely resembled pre-discography scans.
- No new findings of vertebral marrow edema, intradiscal fluid, endplate irregularity, or epidural abnormality were observed.
- Two cases showed findings similar to discitis, but these were pre-existing and related to prior surgery.
Conclusions:
- Uncomplicated lumbar spine discography does not produce MR imaging changes that simulate discitis.
- MR imaging is reliable for evaluating the lumbar spine after discography without confounding infection.