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Discography may hasten disc degeneration, herniation
Ten-year findings suggest patients who have the procedure experience a greater loss in disc height.
MIAMI — Results of a 10-year prospective study suggest that discography can result in accelerated disc degeneration and herniation.
In the multicenter study, 75 patients without severe low back pain who received an MRI and discography were compared to a matched group who had only MRI examination.
Discs that had been exposed to discography demonstrated signs of greater degeneration at 10-year follow-up than discs that were not exposed to the procedure, Eugene J. Carragee, MD, of Stanford University in Stanford, U.S.A., said at the 36th Annual Meeting of the International Society for the Study of the Lumbar Spine (ISSLS), here.
 Carragee told attendees that discs exposed to discography demonstrated signs of greater degeneration. Image: Trace R, Orthopaedics Today Europe |
“We also saw a greater loss of disc height and signal intensity in the group of patients who had discography compared to the control group,” he said.
His team won the Best Clinical Paper Award for their presentation at the ISSLS meeting.
“Disc puncture, even with modern discographic techniques, causes definitive structural injury to intervertebral discs,” he said.
Spine surgeons need to carefully consider the risk and benefit of disc puncture for diagnostic or therapeutic interventions, he noted.
Kenneth A. Pettine, MD, called the investigation “a potentially very disturbing study” and asked Carragee how puncturing the annulus with a small-gauge needle can cause so many problems.
“The kinetics are slow. This takes time to evolve, which is why we are looking at the follow-up results 10 years later,” Carragee said. “It is something we have to be on the lookout for over the long run.”
He added, “Large animal studies with small needles have already shown immediate and progressive injury to the discs with this kind of puncture — for example, in cows — so why would we assume human discs are less vulnerable?”
For more information:
- Eugene J. Carragee, MD, can be reached at the Orthopaedic Spine Center at Stanford University, 300 Pasteur Drive, Room R171, Stanford, CA 94305, U.S.A.; +1-650-723-7797; e-mail: carragee@stanford.edu. He is a consultant for Medtronic, Intrinsic Orthopaedics, Synthes Spine and Wellpoint.
Reference:
- Carragee E, Don A, Hurwitz E, et al. Does discography cause accelerated progression of degeneration changes in the lumbar disc: A ten-year cohort-controlled study. Paper #57. Presented at the 36th Annual Meeting of the International Society of the Study of the Lumbar Spine. May 4-8, 2009. Miami.