A reappraisal of lumbar discography

Five hundred patients with negative or inconclusive pantopaque myelograms were investigated by lumbar discography. Discography remains the ideal complementary examination to demonstrate normal or diseased disc morphology and its findings were confirmed during surgery in 97.8% of explored discs. Discography is also a valuable clinical test since the injection may reproduce the patient's symptoms. Its observations were determinant in the surgeon's decision to explore a disc or not: 97.3% of patients submitted to laminectomy had an abnormal discogram and 73% of these patients experienced reproduction of clinical symptoms during the procedure. Myelography is superior to discography to demonstrate sequestered fragments, pachymeningitis and spinal stenosis, but was nevertheless not helpful in 56% of the patients in whom these diagnoses were made in the operating room.