Cervical discography: Clinical implications from 12 years of experience

Study Design. Positive pain responses provoked in an inclusive series of cervical discograms performed over a 12-year period were categorized by level and reviewed. Objectives. To report the prevalence of cervical pathology over an entire series of patients, to determine whether a reproducible pattern of concordant pain could be associated with each symptomatic level identified, and to calculate the rate of complications. Summary of Background Data. Cloward wrote the first articles explaining the technique of cervical discography and reported on the pain responses induced. Currently, the technique is viewed as an invaluable diagnostic tool, but it also is criticized for failing to contribute unique information beyond that available from imaging studies despite the inherent risks. Methods. A series of 173 cervical discograms performed over 12 years was examined. Pain responses provaked and recorded during discography were grouped by disc level and examined for recurring patterns. The prevalence of disc pathology was calculated. Results. In all. 807 discs were injected, and 404 concordant pain responses (50%) were elicited. Three or more abnormal disc levels were identified in more than half of the patients. Complications developed in identified patients (2.3%). No further complications were reported. Surgical treatment was indicated as viable in only 35 studies. Conclusions. Discography is a safe and valuable diagnostic procedure showing characteristic pain patterns that may have clinical significance. In more than half of the studies, three or more levels were Identified as pain generators, suggesting that treatment decisions based on information from fewer discs injected during discography may be tenuous.