Diagnostic and therapeutic spinal interventions: Diskography

Diskography (provocation diskography, disk stimulation) is an invasive diagnostic test performed to confirm or exclude internal disk disruption as the cause of axial spine pain. Diskography involves injecting fluid into the nucleus of the disk under manometric control; a positive response is reproduction of typical pain. Extensive but indirect literature validates diskography in the lumbar spine; it is less well-supported in the cervical or thoracic spine. Risks include rare instances of infection and neural injury; lumbar diskography may be associated with accelerated disk degeneration. Diskography has utility in establishing a diagnosis of diskogenic pain. When negative, it prevents inappropriate interventions directed at the disk; when positive, it prevents interventions directed at other axial pain generators. Its role in selecting patients for therapies directed at diskogenic pain is limited by the lack of available validated treatments.