Lumbar provocative discography (also referred to as "discography" or discogram) is an invasive diagnostic procedure for evaluation for intervertebral disc pathology. It is usually reserved for persons with persistent, severe

low back pain Low back pain (LBP) or lumbago is a common disorder involving the muscles, nerves, and bones of the back, in between the lower edge of the ribs and the lower fold of the buttocks. Pain can vary from a dull constant ache to a sudden sharp feel ...

(LBP) who have abnormal spaces between vertebrae on magnetic resonance imaging (MRI), where other diagnostic tests have failed to reveal clear confirmation of a suspected disc as the source of pain, and surgical intervention is being considered.

Uses

Spinal MRI is the imaging of choice to investigate the spine and intervertebral discs. Meanwhile, lumbar discography is used to demonstrate degeneration and herniation of lumbar intervertebral discs by injecting a dye into the

nucleus pulposus An intervertebral disc (or intervertebral fibrocartilage) lies between adjacent vertebrae in the vertebral column. Each disc forms a fibrocartilaginous joint (a symphysis), to allow slight movement of the vertebrae, to act as a ligament to hold t ...

of the discs. The procedure is also used to reproduce pain back pain for those who has such symptoms. Lumbar discography is also used to access the response of a subject to anaesthetic injection. Other uses includes: suspected discogenic pain without radicular sign (pain travelling to lower limbs along a

dermatome Dermatome may refer to: * Dermatome (anatomy), an area of skin that is supplied by a single pair of dorsal roots * Dermatome (embryology), the portion of the embryonic paraxial mesoderm, the somite, which gives rise to dermis * Dermatome (instrument ...

), and confirmation of normal intervertebral discs above and below a site before

spinal fusion Spinal fusion, also called spondylodesis or spondylosyndesis, is a neurosurgical or orthopedic surgical technique that joins two or more vertebrae. This procedure can be performed at any level in the spine (cervical, thoracic, or lumbar) and pre ...

. However, evidence supporting the usefulness of lumbar discography in recognising intervertebral disc problems are limited. There is no role for cervical or thoracic discography in diagnosing disc pathologies at the cervical or thoracic regions. For those with local or distant

sepsis Sepsis, formerly known as septicemia (septicaemia in British English) or blood poisoning, is a life-threatening condition that arises when the body's response to infection causes injury to its own tissues and organs. This initial stage is follo ...

, lumbar discography can add to the risk of infective discitis. Those with co-morbities that caused them not to be suitable candidate for surgery is also relatively contraindicated for this procedure.

Procedure

Non-ionic contrast media such as

iopamidol Iopamidol (INN), sold under the brand name Isovue among others, is a nonionic, low-osmolar iodinated contrast agent A contrast agent (or contrast medium) is a substance used to increase the contrast of structures or fluids within the body in m ...

and

iohexol Iohexol, sold under the trade name Omnipaque among others, is a contrast agent used for X-ray imaging. This includes when visualizing arteries, veins, ventricles of the brain, the urinary system, and joints, as well as during computed tomograp ...

are used. Needles are inserted through the back into the disc near the suspect area, guided by

fluoroscopic Fluoroscopy () is an imaging technique that uses X-rays to obtain real-time moving images of the interior of an object. In its primary application of medical imaging, a fluoroscope () allows a physician to see the internal anatomy, structure and ...

imaging. Fluid is then injected to pressurize the disc, and any pain responses are recorded. Discography

This is repeated in random order for the various discs, without the patient knowing which disc is pressurized. This can be used to detect patients who may be exaggerating their symptoms, or to assess their pain response and hence their suitability for recovery from possible surgery (often a

Discectomy A discectomy (also called open discectomy, if done through a 1/2 inch or larger skin opening) is the surgical removal of abnormal disc material that presses on a nerve root or the spinal cord. The procedure involves removing a portion of an int ...

). A

contrast agent A contrast agent (or contrast medium) is a substance used to increase the contrast of structures or fluids within the body in medical imaging. Contrast agents absorb or alter external electromagnetism or ultrasound, which is different from radiop ...

is introduced, and after the procedure, a CT scan identifies leakage from the discs to identify any

spinal disc herniation Spinal disc herniation is an injury to the cushioning and connective tissue between vertebrae, usually caused by excessive strain or trauma to the spine. It may result in back pain, pain or sensation in different parts of the body, and physical ...

. Possible complications include nerve damage,

discitis Discitis, or diskitis, is an infection in the intervertebral disc space that affects different age groups. In adults, it can lead to severe consequences, such as sepsis or epidural abscess, but it can also spontaneously resolve, especially in ch ...

, an infection of the disc. Strong

antibiotics An antibiotic is a type of antimicrobial substance active against bacteria. It is the most important type of antibacterial agent for fighting bacterial infections, and antibiotic medications are widely used in the treatment and prevention o ...

are usually administered as a precaution. Its use in predicting surgical outcomes is sometimes controversial.

History

Lindgren from

Scandinavia Scandinavia; Sámi languages: /. ( ) is a subregion#Europe, subregion in Northern Europe, with strong historical, cultural, and linguistic ties between its constituent peoples. In English usage, ''Scandinavia'' most commonly refers to Denmark, ...

first performed a puncture of normal intervertebral disc for diagnostic purposes in 1941.

References

Bones of the vertebral column Surgical procedures and techniques {{med-diagnostic-stub