It’s no secret that low back pain is a leading cause of “unwanted” lost work days.
Low back pain is not a disease, but instead may be caused by several problems, the most common being degenerative discs. Degenerative discs may also lead to facet joint arthritis pain and “sciatica” nerve pain.
To help pinpoint pain sources, discography was historically offered because MRIs couldn’t reliably identify pain. Discography was used to plan spine surgery, however today spine fusions themselves are being questioned because of long-term fusion concerns.
Discography was introduced in the 1940’s. During discography, x-ray contrast is injected into the center of discs (called the nucleus pulposis), pressurizing those discs in attempt to reproduce symptoms while visualizing disc tears. During discography, contrast pressurizes the disc, and the resultant x-ray picture is referred to as a “discogram”. Although it’s known that MRIs and CTs can’t reliably identify pain, scientific critics of discography state that pressurizing discs from their “inside out” doesn’t necessarily reproduce a natural situation, so any pain a patient experiences during discography, whether similar (concordant) or not, may be irrelevant.
A respected study from Stanford University compared disc degeneration in patients who underwent discography with those who didn’t undergo discography, and all patients were followed for 10 years following discography. This study found that those who underwent discography suffered with accelerated disc degeneration, more new disc herniations, and also significant disc height loss when compared to the control group.
Therefore, we are refining and perfecting a test called an annulogram to replace discography. An annulogram is a more delicate and refined test which injects a smaller volume of x-ray contrast with less pressure, pinpointing only the outer portion of the disc (annulus fibrosis) where pain nerve endings reside. This is because it’s known that pain begins as small, often undetectable outer annular tears, and these outer tears may go unseen in discograms and MRIs.
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