All invasive procedures have associated risks. Traditionally, Discography has been used to identify pain generators in the spine. Some clinicians have opined it was good test, with acceptable low risks primarily due to needle placement and infections. Research regarding longer term effects of discography has suggested it may also be a cause of disk degeneration, and in 2009, Carragee, et al reported increased rates of disk pathology compared to matched controls using modern discography techniques.
Naturally, this cause quite a stir in the Spine Surgery Community, and further research tried to isolate the cause of the discography related disk abnormalities. Various teams have studied the toxicity of steroids, anesthetic agents, and contrast dye on disk nucleus cells and have demonstrated deleterious effects on those cells.
Recently, in the June 29, 2015 Spine Journal On line, Dr. Cueller and team published their results of a 10 year matched cohort study following asymptomatic volunteers who had discography, or matched followup.
The matched groups include volunteers with prior history of cervical disk disease, prior history of lumbar disk herniations that became asymptomatic, and a group with no neck or back pain history, but with a history of a serious psychological distress consistent with a somatization disorder.
You can read the details of the study in the Spine Journal, but the bottom line conclusion was that the asymptomatic volunteers who received discography had statistically increase rates of lumbar surgery, further diagnostic testing, serious back pain episodes, and time off from work.
The Authors outlined the problems with the study, including losing 40 of the initial 150 volunteers to followup, and evaluating a population that will likely have a back problem in the future. Still the Authors expressed concerns about the effects of Discography on normal disks, and questions the value of the test considering the results of this cohort study.
As a Clinician, I have significantly limited my use of Discography for my patients. For those who have a degenerated disk, I may still order the test to confirm the pain generation potential of that degenerated disk. I will most likely be very thoughtful in the use of a so called “Control level” to prove a normal disk is not symptomatic.
As this time, using the control level is still an accepted part of Community practice. Time will tell if it still will be used in that capacity in the future.
- Cuellar JM, Stauff MP, Herzog RJ, Carrino JA, Baker GA, Carragee EJ. Does provocative discography cause clinically important injury to the lumbar intervertebral disc? A 10-year matched cohort study. Spine J. 2016 Mar;16(3):273-80. PubMed PMID: 26133255