Can discoblock replace discography for identifying painful degenerated discs?

Area of Science:

• Orthopedics
• Radiology
• Pain Management

Background:

• Idiopathic degenerated discs (IDD) present diagnostic challenges for surgical decision-making.
• Provocative discography and discoblock are used to evaluate IDD, but their comparative value requires clarification.

Purpose of the Study:

• To intra-individually compare provocative discography and discoblock (disc analgesia) in patients with IDD.
• To reevaluate the diagnostic utility of these procedures by correlating them with clinical parameters and MRI findings.

Main Methods:

• 31 intervertebral IDDs (Pfirrmann III°-IV°) from 26 patients were analyzed using a combined discoblock/discography procedure in an open 1T MRI.
• Correlation analysis included Dallas Discogram Scale, pain discrimination score (PDS), positive discoblock (Numerical Rating Scale [NRS] reduction ≥ 3), Modic changes, high intensity zones (HIZ), patient demographics, and procedural parameters.

Main Results:

• Concordant pain was evoked in 35% of IDDs; discoblock was positive in 64%.
• Discoblock correlated positively with concordant pain, Modic changes, and discography endpoint.
• Patient age, sex, disc degeneration scores (Dallas, Pfirrmann), and HIZ did not correlate with PDS or discoblock results.

Conclusions:

• Discoblock is a valuable adjunct for surgical decision-making in IDD patients.
• It correlates with concordant pain from provocative discography and the presence of Modic changes.
• Assessing pain relief (discoblock) rather than provocation (discography) may offer advantages.