This is a very long topic, so I will just touch on it here and expand on it later.

Provocation of concordant daily pain with lumbar discography has been well demonstrated. This is a purely diagnostic injection in which the patient is put to sleep quickly with propofol, while needles are placed in the center of the discs in question, along with a control disc. Then, I allow the patient to wake up and be fully alert before I start testing. Then, I pressurize the center of the disc with about 1/2 cc of contrast dye. I watch the dye flow out of any disc tears on live xray (fluoroscopy).

But, the most important aspect of the test is the patient’s response to injection. A normal disc only has nerve endings on the outer third periphery of the disc, and the patient will not feel pressurization at all. However, often a disc can morphologically appear abnormal on MRI or discography and not hurt (the exact reason we do discography). For example, take a patient who has two degenerative discs on MRI and has failed conservative care and is considering surgery. A discogram may show that only one of the discs hurts when injected. Therefore, that patient only has a one level surgery that carries a higher success rate than a 2 level surgery.

I use discography to determine what NOT to operate.

by Nathan S. Walters, MD


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