Cervical diskography: Analysis of provoked responses at C2-C3, C3-C4, and C4-C5

BACKGROUND AND PURPOSE: Previous authors have described the locations of pr ovoked responses to cervical diskography from C3-C4 to C6-C7, but we have f ound no description of the findings at C2-C3, This study was undertaken to analyze the sensations provoked during cervical diskography at C2-C3 and to compare the results with those provoked at C3-C4 and C4-C5. METHODS: The locations of diskographically provoked responses from 40 conse cutive patients who had undergone C2-C3, C3-C4, and C4-C5 diskography were analyzed. Only intensely painful (greater than or equal to 7/10) and concor dant responses were considered. Disk morphology on MR images and diskograms was also compared with the provoked responses. RESULTS: Eighteen subjects described either unilateral (n = 10) or bilatera l (usually asymmetric) (n = 8) concordant pain at the craniovertebral junct ion in response to C2-C3 diskography, Nine subjects described either unilat eral (n = 5) or bilateral (n = 4) neck pain during injection. Cephalalgia o r head pain was provoked in 19 subjects, seven bilaterally. Four subjects d escribed either unilateral (n = 3) or bilateral (n = 1) trapezius muscle an d/or shoulder pain. Preliminary MR studies were not helpful, as most C2-C3 disks either appeared normal or exhibited nonspecific signs of degeneration . All disks exhibited either fissuring or extradiskal leakage of contrast m aterial at diskography, regardless of the response provoked, CONCLUSION: Diskography at C2-C3 and C3-C4 frequently produces pain sensati ons in the head, craniovertebral junction, and neck, There is no correlatio n between C2-C3 disk morphology and the diskographically provoked response.