When a patient has severe back pain, it can be difficult to determine the source of their pain, especially if it is a spinal disc. MRI and CT scans can’t reliably diagnose issues in this area, making discography seem necessary in order to identify problematic discs. Unfortunately, discography’s negative effects and associated risks may mean that this test does more harm than good.
What is Discography?
Discography, or discogram as it’s also known, is a test commonly used to evaluate the spinal discs. If you are suffering from back pain and failed to experience relief from conservative treatment, discography will determine whether a degenerative disc is the cause of your back pain. This test is most often used before spinal fusion surgery in order to pinpoint which discs will need to be removed.
In order to evaluate the spinal discs, a dye is injected into the center of the disc or discs that are suspected to be the cause of the pain. This dye exposes tears in the outer part of the disc, making them visible on a CT scan or X-ray. Once injected, if the dye remains within the center of the spinal disc, the disc is normal and has no damage. However, if the dye spreads to the outer portion of the disc, this indicates that there are tears in that layer, and they may be the cause of the patient’s back pain. Another common sign of spinal discs causing back pain is whether the patient feels pain during injection. If a disc is not damaged, there will be very little pain felt during the injection process.2
Why Discography is Controversial
There are many issues with discography, one of them being that this test is not particularly accurate in showing which discs are the cause of back pain, or if spinal discs are even the cause of back pain. There are also risks associated with discography, as there are with any medical procedure including infection, allergic reaction to the dye used, or even injury to the nerves or blood vessels in and around the spine.2
However, studies also show that discography’s negative effects include worsening or accelerating disc degeneration. The results of a ten-year study showed that discs in patients that had been punctured and injected in discography procedures showed a significantly greater acceleration of disc degeneration than the discs of patients that did not undergo discography. These patients also had higher instances of disc herniation and loss of disc height.1 One of the doctors that took part in this study, Eugene J. Carragee, MD, had this to say about the findings: “Disc puncture, even with modern discographic techniques, causes definitive structural injury to the intervertebral discs.”3
Because we now know about discography’s negative effects on spinal discs, it’s important to take all this into consideration before going through with this procedure. Your spine health is important, so it’s crucial that you know all the facts before undergoing any procedure related to your spine. You may also want to take alternatives into consideration, such as annulograms, which are known to put less pressure on the disc and provide a better diagnosis of degenerative disc disease.
- Carragee, E. J., Don, A. S., Hurwitz, E. L., Cuellar, J. M., Carrino, J. A., & Herzog, R. (2009, October 1). 2009 ISSLS Prize Winner: Does discography cause accelerated progression of degeneration changes in the lumbar disc: a ten-year matched cohort study. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/19755936
- Discogram. (2020, February 26). Retrieved from https://www.mayoclinic.org/tests-procedures/discogram/about/pac-20393818
- Discography may hasten disc degeneration, herniation. (2009, July 1). Retrieved from https://www.healio.com/orthopedics/spine/news/print/orthopaedics-today-europe/{beacd010-c7fe-42ab-ba36-76cdac37635b}/discography-may-hasten-disc-degeneration-herniation
