Discography spine is an X-ray examination of the intervertebral disc using contrast. It is used to clarify the cause of pain of unclear genesis, to assess the condition of the discs in cases of multiple lesions, to conduct differential diagnosis between various disc pathologies, to determine indications for surgical intervention, to draw up an operation plan. It includes local administration of a contrast agent into the disc area followed by radiography in two projections. Functional tests are performed according to the indications.
Discography is assigned to identify the source of the pain syndrome, which cannot be detected using other examination methods. The study is used to study the condition of discs with their multilevel lesion, for differential diagnosis of recurrence of intervertebral hernia from scarring, to determine the cause of pain after stabilizing spinal surgery, to decide on the feasibility of surgical intervention and the development of an operation plan.
In modern neurology, cervical and lumbar discography are considered as screening methods in the diagnosis of intervertebral disc pathology. Unlike them, the discography of the thoracic spine is shown only in cases when it is impossible to obtain the necessary information about the condition of the disk by other methods. If it is possible to conduct an MRI of the spine, the indications for discography are sharply narrowed, and the examination of discs in the thoracic region is not applied.
Examination is absolutely contraindicated if the patient has a neurological deficit, signs of an active infectious process, compression of the spinal cord, as well as skin lesions at the site of needle insertion. Spinal canal stenosis at the research level, myelopathy and coagulopathy are relative contraindications.
Methodology of conducting
The technique does not require special training. The patient must submit radiographs of the examined spine so that the neurologist has information about the features of the structure of the vertebrae, the presence of osteophytes and the condition of the spinal canal. The patient’s position during the discography depends on the level at which the study is conducted. When examining the cervical discs, the patient is placed on his back, a roller is placed under the shoulders, and the head is thrown back. During the lumbar disc discography, the patient lies on his side with his knees drawn to his stomach and his chin pressed to his chest.
After treatment of the skin with iodine and alcohol, local anesthesia is performed, needles with mandrels are inserted into the examined discs under the control of fluoroscopy. The introduction of needles in the cervical spine occurs from the front, and in the thoracic and lumbar spine – from behind. Each needle is advanced until its end is in the center of the disc. Then mandrels are removed from the needles in turn, contrast agents are injected (dionone, urotrast, cardiotrast, etc.). Normally, the disk holds 0.5-1 ml of the drug. In the presence of degenerative processes, the volume of the injected agent increases to 2-3 ml.
Radiography is performed in direct and lateral projections. After receiving the pictures, the needles are removed. If necessary, functional radiographs are additionally made. After the discography, the patient is recommended bed rest for 3 days. After examination of the cervical discs, this period must be fixed with a special neck holder or a Trench collar.
In some cases, the discography is complicated by inflammation of the intervertebral disc. Its main cause is the ingress of microorganisms from the patient’s skin into the disc tissue. To prevent inflammation, the patient is prescribed antibiotic therapy, taking into account the sensitivity of the skin microflora. Unlike cervical and lumbar discography, examination of thoracic discs is a complex and dangerous procedure. This is due to the possibility of injury to internal organs located in the chest. The needle is most likely to enter the lung tissue with the development of pneumothorax