[Diagnostic Testing] Does Discography Cause Accelerated Progression of Degeneration Changes in Lumbar Disc: A 10-yr Matched Cohort Study

[Justin]

Spine. Volume 34, Number 21, pp 2338 –2345

Does Discography Cause Accelerated Progression of Degeneration Changes in the Lumbar Disc: A Ten-Year Matched Cohort Study.

Carragee, Eugene J. MD; Don, Angus S. FRACS; Hurwitz, Eric L. DC, PhD; Cuellar, Jason M. MD, PhD; Carrino, John MD; Herzog, Richard MD. (C) 2009 Lippincott Williams & Wilkins, Inc.

Study Design. Prospective, match-cohort study of disc degeneration progression over 10 years with and without baseline discography.

Objectives. To compare progression of common degenerative findings between lumbar discs injected 10 years earlier with those same disc levels in matched subjects not exposed to discography.

Summary of Background Data. Experimental disc puncture in animal and in vivo studies have demonstrated accelerated disc degeneration. Whether intradiscal diagnostic or treatment procedures used in clinical practice causes any damage to the punctured discs over time is currently unknown.

Methods. Seventy-five subjects without serious low back pain illness underwent a protocol MRI and an L3/4, L4/5, and L5/S1 discography examination in 1997. A matched group was enrolled at the same time and underwent the same protocol MRI examination. Subjects were followed for 10 years. At 7 to 10 years after baseline assessment, eligible discography and controlled subjects underwent another protocol MRI examination. MRI graders, blind to group designation, scored both groups for qualitative findings (Pfirrmann grade, herniations, endplate changes, and high intensity zone). Loss of disc height and loss of disc signal were measured by quantitative methods.

Results. Well matched cohorts, including 50 discography subjects and 52 control subjects, were contacted and met eligibility criteria for follow-up evaluation. In all graded or measured parameters, discs that had been exposed to puncture and injection had greater progression of degenerative findings compared to control (noninjected) discs: progression of disc degeneration, 54 discs (35%) in the discography group compared to 21 (14%) in the control group (P = 0.03); 55 new disc herniations in the discography group compared to 22 in the control group (P = 0.0003). New disc herniations were disproportionately found on the side of the anular puncture (P = 0.0006). The quantitative measures of disc height and disc signal also showed significantly greater loss of disc height (P = 0.05) and signal intensity (P = 0.001) in the discography disc compared to the control disc.

Conclusion. Modern discography techniques using small gauge needle and limited pressurization resulted inaccelerated disc degeneration, disc herniation, loss of disc height and signal and the development of reactive endplate changes compared to match-controls. Careful consideration of risk and benefit should be used in recommending procedures involving disc injection.

Key words: disc degeneration, discography, anular puncture, complications.

[KBear]

Wow, that's scary I wonder if that's why a couple of years ago I had only one bad disc. Two discograms later the one above and below are herniated (the controls).

[ajj1001]

It does make sense though, stick a needle in something and it makes it weaker. I've not had one because my initial surgery was an emergency and I've had a further prolapse a couple of discs up.

[Fuzzy]

This study confirms my belief that a disco on my cervical spine would be of very questionable benefit. Having a disco at 4 of my borderline cervical levels raises the risk of problems more then the knowledge that is gained in my case.

Thank you for posting this, Justin.

[Justin]

Modern discography techniques can lead to accelerated disc degeneration

OrthroSupersite
By Lee Beadling, November 2009
Copyright ® 2009 SLACK Incorporated. All rights reserved.

SAN FRANCISCO—Discography, even with the use of smaller-gauge needles and limited pressurization, can result in accelerated disc degeneration, according to the results of a long-term cohort-controlled study.

“Modern discography techniques with smaller pressures and smaller gauge needles did appear to have an accelerated degeneration at 10 years,” Eugene Carragee, MD, said. “But this is not at all a homogenous effect; many of the discs appeared to not be effected at all whatsoever.”

Carragee presented the 10-year results of the prospective, controlled, match-cohort study comparing disc degeneration in patients who did or did not receive discography at the 24th Annual Meeting of the North American Spine Society, here.

The study included 75 patients who did not have serious back pain and received a protocol MRI and an L3/4, L4/5, and/or L5/S1 discography examination in 1997. These patients were compared to a 75-pateint control cohort. For the 10-year follow-up there were 50 discography patients and 52 controls available for study.

MRIs were taken at baseline, 1, 2, and 5 years.

“The MRI readers were blinded to the patients who had the MRI scans,” Carragee said. “We looked for the Pfirmann ratings, herniations, end plate changes and high intensity zone.”

Overall, in all graded or measured parameters the discs that had been exposed to puncture and injection had greater progression of new degenerative findings compared to the noninjected discs.

“The progression of one or more grades on the Pfirmann Grade was greater by a statistical test in the discography group than in the nondiscography group,” Carragee said. However, many of the discs did not progress at all, he noted. “The majority of the ones that were punctured had no progression of Pfirmann grade.”

New disc herniations were increased in the discography group as were Modic changes, he said.

“Careful consideration of risk and benefit should be used in recommending procedures involving disc injection,” Carragee said.

Reference:
Carragee E, Don A, Hurwitz EL, et al. Does discography cause accelerated progression of degeneration changes in the lumbar disc: A ten-year cohort-controlled study. Paper #7. Presented at the 24th Annual Meeting of the North American Spine Society. Nov. 10-14, 2009. San Francisco.