Can Discography Cause Problems?

Can Discography Cause Problems?

Can Discography Cause Problems?

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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.

Citations

  • 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

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Author and Contributor to www.Spine-Health.com – July, 2015

www.Spine-Health.com/author/john-h-shim-md-facs

Chief of Surgery, Mease Countryside and Mease Dunedin Hospitals, Safety Harbor and Dunedin, Florida. 2014-2016.

Orthopaedic Section Chief Mease Countryside Hospital; Safety Harbor, Florida Mease Dunedin Hospital; Dunedin, Florida.2008-2013

Board Member Morton Plant Mease Research Council

Co-Director of Mease Neuro-Ortho Spine Center Mease Dunedin Hospital; Dunedin, Florida.

One of “6 Spine Physicians Ranked #1 on Google” – December 2016

Top Ten Most Liked Spine Surgeons on the Internet – July 2016

2016 Spine Surgeons to Know list – January 2016

2014 Spine Specialists to know list – September 2014

One of Ten Leaders of Certified Spine Programs – December 2011

 

The Best Orthopedics in Tampa

The information provided on this website does not provide or should be considered medical advice. It is not a substitute for diagnosis or treatment of any condition. The information provided is for informational purposes only. You should not rely solely on the information provided on this website in making a decision to pursue a specific treatment or advice. You should consult directly with a professional healthcare provider.

As a condition of using the information on this website, ShimSpine and its physicians are not responsible for any advice, diagnosis, treatment or outcome you may obtain.

ShimSpine.com is completely self-funded. No outside funds are accepted or used. This website does not utilize paid advertising as a source of revenue.
Outpatient Spine Surgery Considerations. www.Spine-Health.com. January 2016.

What is Spinal Stenosis? www.Spine-Health.com. October 2015.

Surgeon insights on the Changing Landscape of Orthopedic Care. OrthopedicToday. June 2014

Chapter 33: Interspinous Spacers. Shim JH, Mazza JS, Kim DH Published in Minimally Invasive Percutaneous Spinal Techniques. Elsevier Health Sciences, Philadelphia, Pennsylvania. (Published 2011)

Chapter 35: Minimally Invasive Percutaneous Lumbar Fusion Technique.Shim JH, Mazza JS, Kim DH Published in Minimally Invasive Percutaneous Spinal Techniques. Elsevier Health Sciences, Philadelphia, Pennsylvania. (Published 2011)

March 2010 Minimally Invasive Transforaminal Lumbar Interbody Fusion American Academy of Orthopaedic Surgeons Annual Meeting New Orleans, Louisiana February 2010

February 2010 A Review of Dynamic Stabilization in the Lumbar Spine Selby Spine Symposium; Park City, Utah

November 2009 Lumbar Spinal Stenosis Community Based Lecture; Tampa, Florida

September 2009 Instructor/Proctor Minimally Invasive Lumbar Cadaver Lab; Tampa, Florida

February 2009 New Spinal Technology: Cervical Disc Replacement and Interspinous Spacers. Selby Spine Symposium; Park City, Utah

February 2008 The Degenerative Spine: The Role of Dynamic Lumbar Stablization and Interspinous Spacers Selby Spine Symposium; Park City, Utah

October 2008 Emerging Technology and Techniques in Spinal Surgery Orthopaedics in the 21st Century Symposium; Morton Plant Mease Healthcare; Largo, Florida

September 2007 Emerging Technology in Spinal Surgery Orthopaedics in the 21st Century Symposium; Morton Plant Mease Healthcare; Largo, Florida

October 2006 Emerging Technology and Techniques in Spinal Surgery Orthopaedics in the 21st Century Symposium; Morton Plant Mease Healthcare; Largo, Florida

May 2005 The Role of Kyphoplasty in the Treatment of Vertebral Compression Fractures Mease Neurosciences Symposium; Clearwater, Florida
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