Is it really worth it?

Discography, a painful imaging technique for the spine that involves the injection of a contrast medium, has long been debated for its efficacy and utility(1,2,3). Even though it has been around since 1948, research to this day still fails to establish Discography as a effective test. It has been suggested that it is an accurate test for only a minute group of conditions, while it is unreliable for disk degeneration, disk bulges and protrusions, as it lacks specificity and leads to unnecessary back surgery (4). Regardless, this procedure is still sees widespread usage as doctors argue it is better than MRI or CT.

New research published in Spine, decided to take a different role, and examine the risks to benefits ratio of a discography. In their experimental animal model, it was shown that the rats that received small needle punctures exhibited a significantly higher rate of herniation, endplate changes, disc grade progression and annular fissures; both in frequency and severity. They also demonstrated a statistically significant decrease in disk height and signal after the injection (5).

Dr. Carragee et al.’s study brings up serious concerns with the usage of discography. Why countinue to utilize a technique that has been so poorly proven to provide usable & correct clinical data, and that also causes what you are attempting to locate and fix. It appears that this is a classic case of Risks far outweighing the benefits.

For a further information on Discography, and a slightly more pro-discography viewpoint, eMedicince provides a good overview.

Sources

1. Derby R, Howard MW, Grant JM, et al. The ability of pressure-controlled discography to predict surgical and nonsurgical outcomes. Spine. Feb 15 1999;24(4):364-71; discussion 371-2

2. Parker LM, Murrell SE, Boden SD, Horton WC. The outcome of posterolateral fusion in highly selected patients with discogenic low back pain. Spine. Aug 15 1996;21(16):1909-16; discussion 1916-7.

3. Knox BD, Chapman TM. Anterior lumbar interbody fusion for discogram concordant pain. J Spinal Disord. Jun 1993;6(3):242-4.

4. Nachemson A. Lumbar discography–where are we today? Spine. Jun 1989;14(6):555-7

5. Eugene J. Carragee, MD; Angus S. Don, FRACS; Eric L. Hurwitz, DC, PhD; Jason M. Cuellar, MD, PhD; John Carrino, MD; Richard Herzog, MD