LUMBAR DISCOGRAPHY - POSITION STATEMENT FROM THE NORTH-AMERICAN-SPINE-SOCIETY DIAGNOSTIC AND THERAPEUTIC COMMITTEE

Study Design. A comprehensive review of the literature dealing with lu mbar discography was conducted. Objective, The purpose of the review w as to generate a position statement addressing criticisms of lumbar di scography, identify indications for its use, and describe a technique for its performance. Summary of Background Data, Lumbar discography re mains a controversial diagnostic procedure. There are concerns about i ts safety and clinical value, although others support its use in speci fic applications. Methods, Articles dealing with lumbar discography we re reviewed and summarized in this report. Results. Most of the recent literature supports the use of discography in select patients. Althou gh not to be taken lightly, many of the serious acid high complication rates were reported before 1970 and have decreased since because of i mprovement in injection technique, imaging, and contrast materials. Co nclusions. Most of the current literature supports the use of discogra phy in select situations. Particular applications include patients wit h persistent pain in whom disc abnormality is suspect, but noninvasive tests have not provided sufficient diagnostic information or the imag es need to be correlated with clinical symptoms. Another application i s assessment of discs in patients in whom fusion is being considered, Discography's role in such cases is to determine if discs within the p roposed fusion segment are symptomatic and if the adjacent discs are n ormal. Discography appears to be helpful in patients who have previous ly undergone surgery but continue to experience significant pain. In s uch cases, it can be used to differentiate between postoperative scar and recurrent disc herniation and to investigate the condition of a di sc within, or adjacent to, a fused spinal segment to better delineate the source of symptoms. When minimally invasive discectomy is being co nsidered, discography can be used to confirm a contained disc herniati on, which is generally an indication for such surgical procedures. Lum bar discography should be performed by those well experienced with the procedure and in sterile conditions with a double needle technique an d fluoroscopic imaging for proper needle placement. Information assess ed and recorded should include the volume of contrast injected, pain r esponse with particular emphasis on its location and similarity to cli nical symptoms, and the pattern of dye distribution. Frequently, disco graphy is followed by axial computed tomography scanning to obtain mor e information about the condition of the disc.