Discography for Patients without Back Pain Can Quicken Disc Degeneration

10-Year Results Find Injected Discs Deteriorate Faster than Non-Injected Discs
Discography for Patients without Back Pain Can Quicken Disc Degeneration

Spinal discs that were exposed to modern discography techniques appeared to degenerate at a greater progression than discs that were not punctured and injected, according to the 10-year results of a study presented at last week’s 24th Annual Meeting of the North American Spine Society (NASS).

The study compared a control group of 75 patients with another 75 patients without back pain who had a protocol MRI and a discography examination on one or several levels of the spine (L3/4, L4/5 and/or L5/S1) back in 1997. Magnetic resonance imaging was taken of the discs 1, 2 and 5 years after, with approximately 50 discography patients and 52 controls available at the 10-year follow up.

According to the researchers, disc degeneration was more progressive in the injected discs than the non-injected discs 10 years later, suggesting to them that even discography with smaller needles and reduced pressure can accelerate degeneration, and reinforcing the need for careful consideration of the benefits and risks of this procedure prior to its undertaking.

A discography is an injection technique that involves pressurizing discs with a sterile liquid with the purpose of inducing pain in a sensitive disc that may be causing disabling back pain, groin pain, hip pain and/or leg pain.

For patients with such pain that has not responded to extensive, non-surgical treatments, a discography may be used to indicate whether a lumbar fusion surgery is necessary. Specifically, if injecting the disc replicates the patient’s discomfort, a fusion may be indicated; if the injection doesn’t reproduce the pain, a fusion would not be the procedure of choice.

Discography is a controversial technique, with those in favor saying it provides information that other tests can not provide and those opposed saying that the responses it evokes in patients are not useful for evaluating back pain.

In relation to the above study’s findings, it’s important to note that although disc degeneration is a natural part of aging, not all people develop symptoms, and also to remember that a disc that looks abnormal on an MRI is not necessarily painful while a normal looking disc can be a source of severe pain.

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OrthoSupersite referencing Carragee E, Don A, Hurwitz EL, et al. Does discography cause accelerated progression of degeneration changes in the lumbar disc: A ten-year cohort-controlled study. Paper #7. Presented at the 24th Annual Meeting of the North American Spine Society. Nov. 10-14, 2009. San Francisco.