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Cervical Discography: Improving therapeutic outcome in the management of symptomatic degenerative disc disease 2007

Interventional Spine

Edward P Lin, M.D.
Per-Lennart Westesson, M.D., Ph.D., D.D.S, ASSR Member
Sudhir Kathuria, M.D., Non ASSR Member

Scientific Poster

Exhibit Panels: 1

Purpose

1. Understand the indications for cervical discography.
2. Review the technical considerations involved in performing safe, diagnostic and reproducible discography, as well as its complications.
3. Identify relevant findings and recognize their impact on therapeutic outcome.

Results

Learning points

1. Magnetic resonance (MR) imaging has dramatically improved sensitivity in detecting multilevel degenerative changes involving intervertebral discs, facet joints, ligaments, vertebral bodies and musculature.
2. MR, however, does not reliably distinguish between symptomatic or asymptomatic degenerative disc disease, and may not identify annular tears of the cervical disc. Surgical intervention may, therefore, yield unsatisfactory results if planning is based on MR results alone.
3. Cervical discography may help identify discs or vertebral endplate pathology that are of clinical significance, and guide therapeutic intervention to specific spinal segments.
4. Proper technique is achieved with thorough knowledge of spinal anatomy and pathology, familiarity with fluoroscopic equipment and imaging, and accurate interpretation of images.
5. Discs may be injected with Omnipaque contrast, which is administered until full capacity is reached, extravasation of contrast external to the disc is identified, or pain is induced, upon which the injection is stopped.
6. Major complications of discography include discitis, prevertebral abscess, and vascular and neural injury, such as cord compression and myelopathy. In a series of 4400 cervical disc injections in 1357 patients, major complications occurred in approximately 0.6% [1].
7. Examples of proper technique, normal and abnormal findings, correlation with MR, therapeutic outcomes and complications will be provided.

Conclusion

Cervical discography is a safe and reliable diagnostic procedure that can improve patient outcome by guiding the management of symptomatic cervical degenerative disc disease.

References

1. Seidman SM, Thompson K, Ducker T. Complications of Cervical Discography: Analysis of 4400 Diagnostic Disc Injections. Neurosurgery 1995; 37: 414-417