Rationale: Discography evaluates the suspected culprit discs with abnormal morphology and, as a control, normal discs. In theory, the combination of imaging that demonstrates disc degeneration or internal disc disruption and provoking the patient’s usual pain confirms a tested disc as a source of pain.

Technology Description: Discography involves image-guided injection of a contrast agent into the nucleus of 1 or more lumbar discs individually to provoke a pain response that reproduces the patient’s usual pain and reveal morphological disc abnormalities via the pattern of contrast spread. Performed under fluoroscopic guidance, discography involves inserting a needle into the center of an intervertebral disc, injecting a contrast agent through the needle, evaluating any pain provoked by the injection, and examining the pattern of contrast spread in the tested disc. The findings of this test are used to guide treatment decision making, with the goal of improving health outcomes.     

Controversy: Discography has remained controversial due to its invasive nature, reports of high false-positive rates in normal discs and asymptomatic individuals, and the lack of a reference standard by which to assess its efficacy in identifying discogenic pain.

Key Questions

  • Does discography provide information that changes patient management or impacts the health outcomes of patients with low back pain (LBP)?
  • How does lumbar discography compare with alternate approaches for identifying disc pathology (i.e., anesthetic discography or functional anesthetic discography)?
  • What are the harms associated with discography?
  • Have definitive patient selection criteria been established for use of discography for LBP?

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