Discography

Discography is a diagnostic procedure used in medicine to evaluate back pain. This minimally invasive procedure helps to identify or confirm the source of pain in the intervertebral discs. Discography is particularly useful in cases where patients continue to experience pain despite normal findings in standard imaging studies, such as magnetic resonance imaging (MRI) or computed tomography (CT) scans.

Procedure

Discography involves the injection of a contrast dye into the nucleus of an intervertebral disc, which is then examined using X-ray imaging, known as fluoroscopy, to assess the integrity of the disc structure. The procedure is performed under local anesthesia, and the patient is awake to provide feedback on the sensations experienced during the injection. This feedback is crucial as it helps to correlate the location of the disc with the patient's pain.

Indications

Discography is indicated for patients with persistent, severe back pain whose origin cannot be determined by other diagnostic methods. It is particularly useful for:

• Assessing the integrity of discs after trauma
• Determining if a disc is the source of pain before spinal fusion surgery
• Evaluating previous surgical sites in patients who continue to experience pain

Risks and Complications

While discography is generally safe, it carries the risk of complications such as:

• Infection
• Discitis (inflammation of the disc)
• Nerve damage
• Allergic reaction to the contrast dye
• Worsening of chronic back pain

Controversy

The use of discography is controversial among medical professionals. Critics argue that the procedure may cause or exacerbate disc degeneration and that its diagnostic value is limited due to the high prevalence of abnormal disc findings in asymptomatic individuals. Proponents, however, believe that when used judiciously, discography can provide valuable information that guides treatment decisions.

Conclusion

Discography is a diagnostic tool for assessing intervertebral discs and identifying pain sources in the spine. Despite its potential risks and the controversy surrounding its use, it remains an important procedure in the diagnostic workup of certain patients with chronic back pain. As with any medical procedure, the decision to undergo discography should be made after a thorough discussion of the potential benefits and risks with a healthcare provider.