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Pressure Increase in Adjacent Discs During Clinical Discography Questions the Methods Validity
Hanna Hebelka1, Andreas Nilsson2, Tommy Hansson2
1Department of Radiology, Sahlgrenska University Hospital, SU/M and.
Spine
|December 25, 2013
Summary
Clinical discography can elevate pressure in adjacent discs, potentially causing false-positive pain responses. This study confirms pressure transmission in human spines, questioning the specificity of discography for single-level pain diagnosis.
Area of Science:
- Spine diagnostics
- Pain management
- Radiological procedures
Background:
- The validity of discography for diagnosing discogenic pain is debated.
- Previous animal studies indicated pressure transmission to adjacent discs during injection.
- Such transmission could lead to inaccurate pain localization.
Purpose of the Study:
- To determine if intradiscal pressure transfers to adjacent discs during clinical discography.
- To assess the clinical relevance of this pressure transmission in patients with discogenic pain.
Main Methods:
- An observational, in vivo clinical study involving 9 patients.
- Performed 25 discograms, measuring intradiscal pressure in adjacent discs using a sensor.
- Injected contrast until predefined pressure, pain, or volume endpoints were met.
Main Results:
- Pressure increase was recorded in 55% of adjacent discs, averaging 13 psi (62% above baseline).
- Pressure transmission occurred in discs with Pfirrmann degeneration grade 3 or higher.
- Injected discs reached an average of 35 psi above opening pressure.
Conclusions:
- Clinical discography demonstrably increases intradiscal pressure in adjacent spinal discs.
- This pressure increase is clinically significant and occurs even with low absolute pressures.
- Pressure transmission poses a major risk for false-positive discography results, challenging its single-level pain provocation ability.
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