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Motion Characteristics of the Functional Spinal Unit During Lumbar Disc Injection (Discography) Including Comparison

Walter S Bartynski1, Vikas Agarwal2, Abdullah S Khan3

  • 1Department of Radiology, Duke University, Durham, North Carolina.

Pain Medicine (Malden, Mass.)
|April 6, 2021
PubMed
Summary

Lumbar discography injection provokes motion in the functional spinal unit, including endplates and facet joints. Degenerative discs show less motion compared to normal discs during this procedure.

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Area of Science:

  • Biomechanical analysis of the spine
  • Diagnostic imaging techniques
  • Pain management interventions

Background:

  • Provocation lumbar discography is used to identify pain-generating discs.
  • The biomechanical impact of the disc injection procedure itself is not well understood.

Purpose of the Study:

  • To assess the motion of the functional spinal unit during disc injection.
  • To compare the biomechanical effects between normal and degenerative discs.

Main Methods:

  • Retrospective analysis of vertebral motion from fluoroscopic images of 91 patients undergoing lumbar discography.
  • Comparison of pre- and post-injection images to evaluate endplate and facet/pedicle motion.
  • Grading of disc morphology using established criteria (Adams criteria).

Main Results:

  • Significant endplate and facet/pedicle motion was observed in most lumbar levels, with high inter-rater agreement.
  • Degenerative discs exhibited significantly less endplate and facet/pedicle motion compared to normal discs.
  • Prominent motion was seen in 61% of degenerative endplates vs. 89% of normal endplates.

Conclusions:

  • Disc injection induces motion in the entire functional spinal unit, effectively 'provoking' it biomechanically.
  • Consideration of facet joint and myotendinous insertion involvement is crucial when pain is provoked during lumbar discography.