Does discography cause accelerated progression of degeneration changes in the lumbar disc: A ten‐year cohort‐controlled study.
Introduction: Experimental disc puncture in animal and in vivo studies have demonstrated accelerated disc degeneration. Whether intra‐discal 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‐S1 discography in 1997. A matched group was enrolled at the same time and underwent the same protocol MRI only. Subjects were followed for 10 years. At seven to ten years after baseline assessment, eligible discography and controlled subjects underwent another protocol MRI examination. MRI graders, blind to group designation, scored both groups for progression of MRI findings.
Results: 50 discography subjects and 52 control subjects were contacted and met eligibility criteria for inclusion. The groups were well‐matched for both clinical and baseline MRI findings. There was more progression of disc degeneration (p = 0.03) and new disc herniation (p = 0.0003) in the discography group compared to the control group. New disc herniations were disproportionately found on the side of the anular puncture (p = 0.0006). Similarly there were more new endplate signal changes (p = 0.04) and anular fissures with bright signal (p = 0.1) in the discography group compared to the controls. 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.
Discussion: Modern discography techniques using small gauge needle and limited pressurization resulted in accelerated 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.