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Discography may quicken disc degeneration

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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 serious low back pain received an MRI and discography examinations in 1997. A matched group was enrolled at the same time and underwent the same 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, said at the 36th Annual Meeting of the International Society for the Study of the Lumbar Spine (ISSLS), here.

“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.

In qualitative MRI findings, Carragee and his colleagues documented new cases of disc herniation, new endplate changes and progression of disc degeneration more frequently in the patients who were exposed to disc injection.

“Disc puncture, even with modern discographic techniques, causes definitive structural injury to IV discs,” he said.

The findings confirm the results of earlier animal and organ culture studies, Carragee noted. As such, orthopedic spine surgeons need to carefully consider the risk and benefit of disc puncture for diagnostic or therapeutic interventions.

The investigation did have a few limitations, according to Carragee, including the fact that study subjects were predisposed to disc degeneration, and the effect may not be the same in everyone. Also, “The rate of degenerative changes is unclear, since we only used two time points in the study. Finally, the results were not homogeneous among the groups. Some discs showed no progression at all,” he said.

Carragee and his colleagues earned the Best Clinical Paper Award for their presentation at the ISSLS meeting.

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.