Discography: A review

Abstract

Background context: Discography is used today as the basis of the diagnosis of discogenic back and neck pain. As such, it plays a pivotal role in the formulation of treatment plans for patients complaining of chronic axial spine pain. Purpose: A brief history of discography is described here, followed by a discussion of the current uses of discography, the technique involved, and recent studies questioning its validity. Study design/setting: A selective review of discography articles from peer-reviewed literature from 1967 to 2000 is provided. We included articles analyzing the validity of discography as well as those concerning its proper use, technique, and complications. Methods: Articles relevant to the subject of discography were systematically reviewed for recommendations regarding technique, the interpretation of results, and conclusions regarding its validity. Results: The specificity of discography is dramatically affected by the characteristics of the patient examined. In a patient with chronic pain states and psychiatric risk factors, the specifity was determined to be at most 20%. In healthy patients with no chronic pain states and a normal psychiatric profile, the specificity was found to be at most 90%. The ability of a patient to determine reliably the concordancy of pain provoked during discography is poor. We could find no data addressing the sensitivity of the study. Conclusions: Clinicians who use discography to determine treatment pathways for their patients need to critically examine the validity of the test. Recent studies examining the specificity of discography have led us to proceed much more cautiously in interpreting the results of discography. © 2001 Elsevier Science Inc. All rights reserved.