The Role of Discography in the Evaluation of Degenerative Disc Disease

Lumbar discography is generally used to evaluate discs that are suspected of being a source of clinical pain. Although used for more than 50 years, it remains controversial. In this review of current literature, we will discuss issues related to the controversy including the disc as a pain generator, appropriate technique of performing discography, and literature evaluating discography in asymptomatic subjects. There are studies supporting that discs in which pain is provoked during injection are physiologically different from nonpainful discs. Primarily, they are characterized by neovascularization deep into the annular layers and granulation tissue within the disc along tears in the annulus. The technique of performing discography should not be unduly painful. The use of pressure-controlled injection may provide additional diagnostic information. Studies investigating discography in subjects with no back pain are difficult to evaluate clinically. While several of these studies support earlier findings that patients with a strong psychological component to their symptoms may be more likely to have unreliable pain responses, these patients are generally poor surgical candidates and intervention should be undertaken cautiously. Discography appears to be a helpful diagnostic tool in evaluating discs as a possible cause of symptoms. As with any intervention, the results are only as beneficial as the technique, its interpretation, and decisions made based on its results.