I’m Stopping the Use of Discography

I’m Stopping the Use of Discography

I’m Stopping the Use of Discography

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For many chronic back pain patients,  a technique called discography has been used to determine the need for surgery.     The procedure has been controversial,  and a hotly debated topic by spine specialists.

The procedure usually means a small needle is introduced into a disk,  and chemicals (usually saline,  contrast dye,  and some lidocaine) are injected into the disk.  When the chemicals are injected,  the disk is pressurized.  If the patient experiences a specific kind of pain,  the discography study will be considered concordant.  Most of the time,  a asymptomatic “normal” disk is also injectioned.   The theory is that a “normal” disk should not cause any pain.  That is considered a control level.  If you have this contrasting response,  the study is considered significant.

The point,  counter-point can be summarized by the following two statements:

  • For surgeons who utilized the technique,  it was a useful tool to determine the need for fusion or discectomy surgery.   
  • For surgeons who had concerns,  it was not a reliable test,  and often led to additional surgery without long term benefit.

Within the debate about the relevance of the discography test,  there was a concern about the potential long term effects of the procedure itself.

Originally,  it was thought not to have any complications other than the pain associated with the technique,  and the small potential for infection.

Now,  more and more information show there may be long term effects that may cause damage to the disk that is injected.    The reasons are multiple.

  1. The injection materials,  contrast dye and lidocaine turn out to potentially cause damage to the cells of the disk.
  2. Pressurization of the disk may cause damage to the disk
  3. Puncturing the disk may start the disk degeneration process.

Recently  Dr. Eugene Carragee and colleagues reviewed the 10 year results of volunteers who underwent discography,  compared to a matched group who had all the same characteristics,  but did not undergo the procedure.  While there was not 100% followup,  the rates of spine surgery of the discography group was almost a 4 fold more than the group that did not have the procedure.    Remember that this group of volunteers had no or minimal back pain symptoms.    While one study does not automatically make the case that discography can be a problem,  there are plenty of other studies that support caution,  or termination of the use of the discography technique.

If your surgeon recommends discography,  please make sure you understand why he/she is recommending the procedure,  and ask if there is an alternative.

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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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