What is the role of discography in the diagnosis of cervical disc disease?

Updated: Apr 16, 2020
  • Author: Michael B Furman, MD, MS; Chief Editor: Dean H Hommer, MD  more...
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Answer

See the list below:

  • Provocative cervical discography has been controversial since its introduction in 1957 by Smith. (Examples of discography appear below.)

  • This imaging procedure involves sterile-technique placement of spinal needles into cervical intervertebral discs

  • At least 2 different techniques exist for performing this procedure.

    • The paravertebral technique uses digital palpation to retract vital soft-tissue structures (eg, trachea, carotid artery, esophagus).

    • The oblique approach obviates the need for digital palpation. After spinal needles are placed within the center of the nucleus pulposus, contrast is injected to determine internal disc architecture and any pain response provoked.

  • Provocative discography is the only procedure that can determine whether a disc serves as the pain generator.

  • Discomfort and invasiveness render this procedure less desirable than cervical MRI, which provides much of the anatomical information that provocative discography does.

  • Provocative cervical discography identifies symptomatic disc(s), assisting in evaluation of patients with inconclusive diagnostic tests and presurgical fusion planning.

  • Contraindications to provocative discography include large disc herniation and midsagittal spinal canal diameter of less than 12 mm.

  • Complications include discitis, epidural abscess, quadriplegia, stroke, pneumothorax, nerve injury, and spinal cord injury. The reported rate of cervical discitis is 0.37%.

  • Discography should be performed at all accessible cervical levels, given the high frequency of multilevel symptomatic cervical discs.

  • Provocative discography may identify poor surgical candidates, thereby improving fusion outcomes.

  • A systematic review of cervical discography has found that if performed using the International Association for the Study of Pain (ISAP) criteria, cervical discography may be a useful tool for the evaluation of discogenic neck pain without disc herniation or radiculitis. Cervical discography was found to have level II-2 strength of evidence for diagnostic accuracy. [30]

  • See the images below.

    Cervical discography. Anteroposterior fluoroscopic Cervical discography. Anteroposterior fluoroscopic image.
    Cervical discography. Lateral fluoroscopic image. Cervical discography. Lateral fluoroscopic image.

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