Thoracic discography in healthy individuals - A controlled prospective study of magnetic resonance imaging and discography in asymptomatic and symptomatic individuals

Study Design. A prospective case-control investigation. Objectives. To determine the responses to thoracic discography of asymptoma tic individuals. Summary of Background Data. Literature regarding lumbar and cervical discog raphy reveals that even morphologically abnormal discs often are not painfu l, whereas painful discs typically exhibit anular or endplate disruption. Methods. Ten adult lifelong asymptomatic volunteers, ages 23 to 45 years, u nderwent magnetic resonance imaging of the thoracic spine, followed by four -level discography. Provocative responses were graded on a scale of 0 (no s ensation) to 10 (extreme pain or pressure), and filmed discs were graded us ing a modified Dallas scheme. Concomitantly, 10 nonlitigious adults (6 men and 4 women, ages 31 to 55 years) experiencing chronic thoracic pain were s imilarly studied as a control group. Results. The mean pain response in the asymptomatic volunteers was 2.4/10. Three discs were intensely painful (scores of 7/10, 8/10, 10/10), with all three exhibiting prominent endplate irregularities and anular tears typical of thoracolumbar Scheuermann's disease. On discography, 27 of 40 discs wer e abnormal, with endplate irregularities, anular tears, and/or herniations. Ten discs read as normal on magnetic resonance imaging showed anular patho logy on discography. In the group with chronic thoracic pain, the average p ain response was 6.3/10 (P < 0.05). Of the 48 discs studied, 24 were concor dantly painful, with a pain response of 8.5/10 (P < 0.05); 17 had nonconcor dant pain/pressure, with an average pain of 4.8/10 (P < 0.05); and 5 had no response. On magnetic resonance imaging 21 of the 48 discs appeared normal . However, on discography, only 10 were judged as normal. Conclusions. On discography, thoracic discs with prominent Schmorl's nodes may be intensely painful, even in lifelong asymptomatic individuals, but th e pain is unfamiliar or nonconcordant. Thoracic discography may-demonstrate disc pathology not seen on magnetic resonance imaging.