LUMBAR DISCOGRAPHY FOLLOWED BY COMPUTED-TOMOGRAPHY - REFINING THE DIAGNOSIS OF LOW-BACK-PAIN

Two hundred fifty patients with low-back pain who under- went lumbar discography followed by computed tomog- raphy (CT) are the subject of this prospective study. In 93% of the patients, these combined imaging techniques provided additional useful diagnostic information that affected patient management and the selection of treat- ment alternatives. Lumbar discography followed by CT proved valuable in determining the significance of equiv- ocal or multiple level abnormalities, determining the type of disc herniation, defining surgical options, and evaluat- ing the previously operated spine. In 94% of patients who had surgery, CT-discography correctly predicted the type of disc herniation as protruded, extruded, sequestrated, or internally disrupted. Computed tomography-discog- raphy may be more sensitive than magnetic resonance imaging (MRI) in the early stages of disc degeneration because 18 of 177 discs with a normal Tz-weighted image were discographically abnormal and the CT-discogram revealed annular tears or radial fissuring. The radio- graphic morphology of the normal herniated and degen- erative lumbar discs shown by CT-discography gives unique insight into the pathogenesis of disc degenera- tion. The complications that followed the 750 discograms were one case of urticaria and one disc space infection. Even with the availability of high resolution CT and MRI, lumbar discography remains the only pain provocation challenge to the lumbar disc. © Lippincott-Raven Publishers.