Discograms: Cervical, thoracic, and lumbar

Clinical and radiographic examination alone may be insufficient to confirm pain sources of the intervertebral disc, which is a common source of chronic axial pain. Precise controlled discography procedures may provide diagnostic confirmation that a specific intervertebral disc is responsible for the patient's axial spine pain. Lumbar discography has been widely used for evaluating discogenic LBP. An important recent advance in discography was the introduction of pressure-controlled manometric discography, permitting control of intra-discal pressure and the injection speed of contrast dye. Using pressure-controlled manometric discography and precise criteria for positive discography (e.g., reproducible VAS pain over 6/10 with <50 psi intradiscal pressure and <3.5 ml total volume) no false positives are obtained for the diagnosis of discogenic LBP. Cervical discography is a safe and valuable diagnostic procedure if done by the highly trained and competent interventionalist with expertise in the procedure. It is not a screening procedure but rather a confirmatory one. Even MRI is a useful adjunct to cervical discography, there are some MRI patterns that cannot be considered pathologic, and discography is required to diagnose discogenic pain syndrome. Thoracic discography can be performed safely as a reliable tertiary diagnostic procedure to determine if degenerated discs on MR studies are related to clinical complaints. It, as of the lumbar spine, can reveal the true source of pain and thus lead to precise and effective treatment.