Skip to main content

Advertisement

SpringerLink
Log in

Discography

  • Published:
Current Review of Pain Aims and scope Submit manuscript

Abstract

Discography is a diagnostic tool that has been used for many years. Although controversial, it provides a physiologic test for evaluation of a disc with a volumetric, manometric, radiographic, and pain-provocative challenge. Although it has a controversial past, when the anatomy and pathophysiology are considered particularly in relation to intradiscal pressure and applied loads (that correlate with daily activities of the patient), the interpretation of the results of discography become more objective and reproducible. As with any procedure, indications for patient selection are an important step in successful outcomes. The equipment and technique used for performing discography using a manometry system are described in this article, as are a review of complications and outcomes. Discography is a safe, accurate, reproducible, objective diagnostic tool when tested for volume, pressure, fluoroscopic changes, and pain provocation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. Guyer RD, Ohnmeiss DD: Contemporary concepts in spine care: lumbar discography. Spine 1995, 20:2048–2059.

    Article  CAS  PubMed  Google Scholar 

  2. Bernard Jr TN: Don’t discard discography. Radiology 1987, 162:285.

    Article  PubMed  Google Scholar 

  3. Bernard Jr TN, Kirkaldy-Willis WH: Making a specific diagnosis. In Managing Low Back Pain, edn 2. Edited by Kirkaldy-Willis WH. New York: Churchill-Livingstone; 1988:209–227.

    Google Scholar 

  4. Tehranzadeh J: Discography 2000. Radiol Clin North Am 1998, 36:463–495. Discography is an invasive and controversial procedure that can be used as a complimentary test to MR imaging or a CT myelogram prior to surgery. Correlation of discography with cross-sectional imaging studies is reviewed and the surgical outcome is discussed.

    Article  CAS  PubMed  Google Scholar 

  5. Linblom K: Diagnostic puncture of interveterbral disks in sciatica. Acta Orthop Scand 1948, 17:231–239.

    Article  Google Scholar 

  6. Hirsch C: An attempt to diagnose the level of a disc lesion clinically by disc puncture. Acta Orthop Scand 1948, 18:132.

    Article  Google Scholar 

  7. Erlacher RR: Nucleography. J Bone Joint Surg 1952, 34B:204–210.

    Google Scholar 

  8. Collins HR: An evaluation of cervical and lumbar discography. Clin Orthop 1975, 107:133–138.

    Article  PubMed  Google Scholar 

  9. Holt EP: The question of lumbar discography. J Bone Joint Surg 1968, 50:720–726.

    PubMed  Google Scholar 

  10. Simmons JW, April CN, Dwyer AP, Brodsky AE: A reassessment of Holt’s data on: the question of lumbar discography. Clin Orthop 1988, 237:120–124.

    PubMed  Google Scholar 

  11. Fox L: Lumbar discography: a myelographic correlation. Acta Neurol Latinoamer 1966, 12:114–124.

    CAS  Google Scholar 

  12. Wiley JJ, Macnab I, Wortzman G, et al.: Lumbar discography and its clinical applications. Canadian J Surg 1986, 11:280–289.

    Google Scholar 

  13. Crock HV: Internal disc disruption. A challenge to disc prolapse fifty years on. Spine 1986, 11:650–653.

    Article  CAS  PubMed  Google Scholar 

  14. Bogduk N: Lumbar discography. Spine 1996, 21:402–404.

    Article  CAS  PubMed  Google Scholar 

  15. Inoue H: Three dimensional architecture of lumbar intervertebral discs. Spine 1981, 6:138–146.

    Article  Google Scholar 

  16. Bogduk N: The inter-body joint and the intervertebral discs. In Clinical Anatomy of the Lumbar Spine, edn 3. New York: Churchill Livingstone; 1997:16.

    Google Scholar 

  17. Marchand F, Ahmed AM: Investigation of the laminate structure of lumbar disc annulus fibrosus. Spine 1990, 15:402–410.

    Article  CAS  PubMed  Google Scholar 

  18. Armstrong JR: Lumbar Disc Lesions, edn 3. Edinburgh: Churchill Livingstone; 1965:13.

    Google Scholar 

  19. Jayson MIV, Barks JS: Structural changes in the intervertebral disc. Ann Rheum Dis 1973, 32:10–15.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  20. Peacock A: Observations on the prenatal development of the intervertebral disc in man. J Anat 1951, 85:260–274.

    PubMed Central  CAS  PubMed  Google Scholar 

  21. Moore KL: Clinically Oriented Anatomy, edn 3. Baltimore: Williams and Wilkins; 1992:342–343.

    Google Scholar 

  22. Hirsch C, Paulson S, Sylven B, Snellman O: Biophysical and physiological investigations on cartilage and other mesenchymal tissues. IV. Characteristic of human nuclei pulposi during aging. Acta Orthop Scand 1952, 22:175–183.

    Article  CAS  PubMed  Google Scholar 

  23. Nachemson A: Measurement of intradiscal pressure. Acta Orthop Scand 1959, 28:269–289.

    Article  CAS  PubMed  Google Scholar 

  24. Puschel J: Der wasserhalt normaler und degenerierter zwischenwirbelscheiben. Beitr Z Path Anat UZ Allg Path 1930, 84:123–130.

    CAS  Google Scholar 

  25. Keyes DC, Compere EL: The normal and pathological physiology of the nucleus pulposus of the intervertebral disc. An anatomical, clinical and experimental study. J Bone Joint Surg 1932, 14:897–938.

    Google Scholar 

  26. Sylven B: On the biology of nucleus pulposus. Acta Orthop Scand 1950, 20:275.

    Article  Google Scholar 

  27. Fabris G, Lavaroni A, Leonardi M, et al.: Discography. Del Centauro Udine, Italy, European Society of Neuroradiology, 1991.

    Google Scholar 

  28. Virgin WJ: Experimental investigations into the physical properties of the intervertebral disc. J Bone Joint Surg 1951, 33B:607–611.

    Google Scholar 

  29. Nachemson AL: Disc pressure measurements. Spine 1981, 6:93–97.

    Article  CAS  PubMed  Google Scholar 

  30. Beard HK, Stevens RL: Biochemical changes in the intervertebral disc. In The Lumbar Spine and Backache, edn 2. Edited by Jayson MIV. London: Pitman; 1980:407–436.

    Google Scholar 

  31. Naylor A: Intervertebral disc prolapse and degeneration. The biochemical and biophysical approach. Spine 1976, 1:108–114.

    Article  Google Scholar 

  32. Naylor A, Shental R: Biochemical aspects of intervertebral discs in aging and disease. In The Lumbar Spine and Backache. Edited by Jayson MIV. New York: Grune & Stratton; 1976:317–326.

    Google Scholar 

  33. Nachemson A: Lumbar intradiscal pressure. Acta Orthop Scand 1960, 43(suppl):1–104.

    Article  CAS  Google Scholar 

  34. Adams MA, Hutton WC: The effect of posture on the fluid content of lumbar intervertebral discs. Spine 1983, 8:665–671.

    Article  CAS  PubMed  Google Scholar 

  35. Ohshima H, Tsuji H, Hirano N, et al.: Water diffusion pathway, swelling pressure, and biomechanical properties of the intervertebral disc during compression load. Spine 1989, 14:1234–1244.

    Article  CAS  PubMed  Google Scholar 

  36. Lu YM, Hutton WC, Gharpuray VM: The effect of fluid loss on the viscoelastic behavior of the lumbar intervertebral disc in compression. J Biomech Eng 1998, 120:48–54.

    Article  CAS  PubMed  Google Scholar 

  37. Wilke H-J, Neef P, Caimi M, et al.: New in vivo measurements of pressures in the intervertebral disc in daily life. Spine 1999, 24:755–762. The goal of this study was to measure intradiscal pressure to complement earlier data from Nachemson with dynamic and long-term measurements over a broad range of activities. It can be cautiously concluded that the intradiscal pressure during sitting may in fact be less than that in erect standing, that muscle activity increases pressure, that constantly changing position is important to promote flow of fluid (nutrition) to the disc, and that many of the physiotherapy methods studied are valid, but a number of them should be re-evaluated.

    Article  CAS  PubMed  Google Scholar 

  38. Botsford DJ, Esses SI, Ogilvie-Harris DJ: In vivo diurnal variation in intervertebral disc volume and morphology. Spine 1994, 19:935–940.

    Article  CAS  PubMed  Google Scholar 

  39. Sato K, Kikuchi S, Yonezawa T: In vivo intradiscal pressure measurement in healthy individuals and in patients with ongoing back problems. Spine 1999, 24:2468–2474. The data obtained from this study are fundamental to understanding the pathomechanisms and biomechanical problems of disc disease.

    Article  CAS  PubMed  Google Scholar 

  40. Rauck R: Lumbar Discography. Available at: http:// www.wfubmc.edu/pcc/Information%2ClumbarDiscography.htm. Accessed October 1999.

  41. Eyring EJ: The biochemistry and physiology of the intervertebral disk. Clin Orthop 1969, 67:16–28.

    CAS  PubMed  Google Scholar 

  42. Roberts S, Menage J, Urban PG: Biochemical and structural properties of the cartilage end-plate and its relation to the intervertebral disc. Spine 1989, 14:166–174.

    Article  CAS  PubMed  Google Scholar 

  43. Saunders JB de C, Inman VT: Pathology of the intervertebral disk. Arch Surg 1940, 40:380–416.

    Google Scholar 

  44. Coventry MB, Ghormley RK, Kernohan JW: The intervertebral disc: its microscopic anatomy and pathology. Part I. Anatomy, development, and physiology. J Bone Joint Surg 1945, 27:105–112.

    Google Scholar 

  45. MacNab I: Backache. Philadelphia: Williams and Wilkins; 1977:4–7.

    Google Scholar 

  46. Coventry MB: Anatomy of the intervertebral disc. Clin Othop 1969, 67:9–15.

    CAS  Google Scholar 

  47. Maroudas A, Nachemson A, Stockwell R, Urban J: Some factors involved in the nutrition of the intervertebral disc. J Anat 1975, 120:113–130.

    PubMed Central  CAS  PubMed  Google Scholar 

  48. Brodsky AE, Binder WF: Lumbar discography. Spine 1979, 4:110–120.

    Article  CAS  PubMed  Google Scholar 

  49. Walsh TR, Weinstein JN, Spratt KF, et al.: Lumbar discography in normal subjects. J Bone Joint Surg Am 1991, 72A:1081–1088.

    Google Scholar 

  50. Word GW: Lower back pain and disorders of the intervertebral disc. In Campbell’s Operative Orthopaedics. Edited by Crenshaw AH. St. Louis: C.V. Mosby; 1987:3255–3321.

    Google Scholar 

  51. Heggeness MH, Doherty BJ: Discography causes end plate deflection. Spine 1993, 18:1050–1053.

    Article  CAS  PubMed  Google Scholar 

  52. Arnoldi CC: Intraosseus hypertension: a possible cause of low back pain? Clin Orthop 1976, 115:30–34.

    PubMed  Google Scholar 

  53. Esses SI, Botford DJ, Kostuik JP: The role of external spinal skeletal fixation in the assessment of low back disorders. Spine 1989, 14:594–601.

    Article  CAS  PubMed  Google Scholar 

  54. Hanaik K, Kawai K, Itoh Y, et al.: Simultaneous measurement of intraosseus and cerebrospinal fluid pressures in lumbar region. Spine 1985, 10:64–68.

    Article  Google Scholar 

  55. Nakamura S, Takahashi K, Takahashi Y, et al.: Origin of nerves supplying the posterior portion of lumbar intervertebral discs in rats. Spine 1996, 21:917–924.

    Article  CAS  PubMed  Google Scholar 

  56. Luschka HV: Die Nerven des Menschlichen Wirbelkanales. Tubingen: H Laupp; 1850.

    Google Scholar 

  57. Wiberg G: Back pain in relation to the nerve supply of the intervertebral disc. Acta Orthop Scand 1949, 19:211–221.

    Article  CAS  PubMed  Google Scholar 

  58. Nakamura S, Takahashi K, Takahashi Y, et al.: The afferent pathways of discogenic low-back pain: evaluation of L2 spinal nerve infiltration. J Bone Joint Surg Br 1996, 78B:606–612.

    Google Scholar 

  59. Malinsky J: The ontogenetic development of nerve terminations in the intervertebral discs of man. Acta Anat 1959, 38:96–113.

    Article  CAS  PubMed  Google Scholar 

  60. Weinstein J, Claverrie W, Gibson S: The pain of discography. Spine 1988, 13:1344–1348.

    Article  CAS  PubMed  Google Scholar 

  61. Schwarzer AC, Aprill CN, Derby R, et al.: The prevalence and clinical features of internal disc disruption in patients with chronic low back pain. Spine 1995, 20:1878–1883.

    Article  CAS  PubMed  Google Scholar 

  62. Gresham J, Miller R: Evaluation of the lumbar spine by discography and its use in selection of proper treatment of the herniated disc syndrome. Clin Orthop 1969, 67:29–41.

    CAS  PubMed  Google Scholar 

  63. McCullough JA, Waddell G: Lateral lumbar discography. Br J Radiol 1978, 51:498–502.

    Article  Google Scholar 

  64. Matsui H, Tsuji H, Itoh T, et al.: Significance of tangential views in lumbar discography. Clin Orthop 1987, 221:165–171.

    PubMed  Google Scholar 

  65. Aprill C, Bogduk N: High-intensity zone: a diagnostic sign of painful lumbar disc on magnetic resonance imaging. Br J Radiol 1992, 65:361–369.

    Article  CAS  PubMed  Google Scholar 

  66. Videman T, Malmivaara A, Mooney V, et al.: The value of the axial view in assessing discograms—an experimental study with cadavers. Spine 1987, 12:299–304.

    Article  CAS  PubMed  Google Scholar 

  67. Pease CN: Injuries to the vertebrae and intervertebral discs following lumbar puncture. Am J Dis Child 1934, 849–860.

  68. Desezes S, Leyernieus J: Les accidents de la discographic. Rev Rheumatique 1952, 19:1027–1033.

    Google Scholar 

  69. Goldie I: Interveterbral disc changes after discography. Acta Clin Scand 1957, 113:438–439.

    CAS  Google Scholar 

  70. Johnson RG: Does discography injure normal discs? An analysis of recent discograms. Spine 1989, 14:363–366.

    Article  CAS  PubMed  Google Scholar 

  71. Flanagan MN, Chung BU: Roentgenographic changes in 188 patients 10 to 20 years after discography and chemonucleolysis. Spine 1986, 11:444–448.

    Article  CAS  PubMed  Google Scholar 

  72. Fraser RD, Osti OL, Vernon-Roberts B, et al.: Discitis after discography. J Bone Joint Surg 1987, 69b:26–35.

    Google Scholar 

  73. Osti OL, Fraser RD, Vernon-Roberts B, et al.: Discitis after discography—the role of prophylactic antibiotics. J Bone Joint Surgery 1990, 72b:271–274.

    Google Scholar 

  74. Lehmer SM, Dawson MH, O’Brien JP: Delayed pain response after lumbar discography. Eur Spine J 1994, 3:28–31.

    Article  CAS  PubMed  Google Scholar 

  75. Walsh TR, Weinstein JN, Spratt KF, et al.: Lumbar discography in normal subjects: a controlled, prospective study. J Bone Joint Surg 1990, 72A:1081–1088.

    Google Scholar 

  76. Guyer RD, Ohnmeiss DD: Lumbar discography. In Contemporary Concepts in Spine Care—North American Spine Society. July 1993.

  77. Yu SW, Haughton VM, Sether LA, Wagner M: Comparison of magnetic resonance and discography in detecting radial tears of the annulus: a post-mortem study. Am J Neuro Radiol 1989, 10:1077–1081.

    CAS  Google Scholar 

  78. Horton WC, Daftari TK: Which disc as visualized by magnetic resonance imaging is actually a source of pain? A correlation between magnetic resonance imaging and discography. Spine 1992, 17(6 suppl):S164–171.

    Article  CAS  PubMed  Google Scholar 

  79. Kornberg M: Discography and magnetic resonance imaging in the diagnosis of lumbar disc disruption. 1989, 14:1368–1372.

    CAS  Google Scholar 

  80. Zucherman J, Derby R, Hsu K, et al.: Normal magnetic resonance imaging with abnormal discography. Spine 1988, 13:1355–1359.

    Article  CAS  PubMed  Google Scholar 

  81. Osti OL, Fraser RD: MRI and discography of annular tears and intervertebral disc degeneration. A prospective clinical comparison. J Bone Joint Surg 1992, 74B:431–435.

    Google Scholar 

  82. Greenspan A, Apmaro EG, Gorczyca DP, Montesano PX: Is there a role of discography in the era of magnetic resonance imaging? Prospective correlation and quantitative analysis of computed tomography-discography, magnetic resonance imaging, and surgical findings. J Spinal Disord 1992, 5:26–31.

    Article  CAS  PubMed  Google Scholar 

  83. Sachs BL, Vanharanta H, Spivey MA, et al.: Dallas discogram description: a new classification of CT/discography in low-back disorders. Spine 1987, 12:287–294.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Anesthesiology and Pain Management, Texas Tech University Health Sciences Center, 3601 4th Street, Room 1C282, 79430, Lubbock, TX, USA

    Susan R. Anderson MD & Brian Flanagan MD

Authors
  1. Susan R. Anderson MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Brian Flanagan MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Anderson, S.R., Flanagan, B. Discography. Current Review of Pain 4, 345–352 (2000). https://doi.org/10.1007/s11916-000-0017-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11916-000-0017-3

Keywords

Search

Navigation