Diagnostic and therapeutic spinal interventions: Diskography

Area of Science:

• Spine diagnostics
• Pain management
• Interventional radiology

Background:

• Axial spine pain is often challenging to diagnose.
• Internal disc disruption is a potential cause of axial spine pain.
• Accurate diagnosis is crucial to avoid inappropriate interventions.

Purpose of the Study:

• To evaluate the diagnostic utility of diskography for axial spine pain.
• To assess the role of diskography in confirming or excluding internal disc disruption.
• To review the limitations and risks associated with diskography.

Main Methods:

• Diskography involves injecting fluid into the nucleus of the intervertebral disc under manometric control.
• A positive response is defined as reproduction of the patient's typical pain.
• Literature review to assess evidence supporting diskography in different spinal regions (lumbar, cervical, thoracic).

Main Results:

• Diskography is validated in the lumbar spine, with less support in the cervical or thoracic spine.
• Positive diskography can confirm discogenic pain and prevent interventions targeting other pain generators.
• Negative diskography can help exclude discogenic pain, preventing unnecessary disc-directed treatments.

Conclusions:

• Diskography is a valuable tool for diagnosing discogenic pain.
• The procedure has limitations, including risks of infection, neural injury, and potential accelerated disc degeneration.
• Its utility in patient selection for specific therapies is currently limited due to the lack of validated treatment options.