Devoted to diagnostic and interventional spine imaging and therapeutics

Library

Preliminary experience with functional anesthetic discography 2007

Interventional Spine

Jonathan S Luchs, MD,
Alexandre DeMoura, MD, Non ASSR Member
Mona Cho, MD, Non ASSR Member
Orlando Ortiz, MD, MBA, ASSR Member

Scientific Paper

Purpose

To describe our preliminary experience with functional anesthetic discography (FAD) in the evaluation of patients with suspected discogenic low back pain.

Methods & Materials

FAD was performed in 19 consecutive patients (13 male, 6 female; mean age 47.2 years, range 34 to 69 years) who underwent lumbar discography for suspected discogenic low back pain. A total of 53 potentially pain-producing discs were studied. A 21 gauge FAD catheter was placed into one or more potentially pain producing discs as determined by a provocative discograms (32 discs) or abnormal discograms (26 discs) study using an over-the-wire exchange technique. Patients were kept blind to the level of disc injection and to the level of FAD placement. At the completion of the discogram, a multidetector CT scan was obtained in order to analyze the injected discs for the presence of radial tears and other pathology using the modified Dallas discogram scale. Patients were subsequently examined before and after (0, 5, 10, and 15 minutes post disc anesthetic injection) the injection of the disc via the FAD catheter using 1-2 mL of 0.5 to 2% local anesthetic agent. Patients were asked to perform maneuvers that would typically elicit their pain symptoms and their pain response was recorded.

Results

19 out of 29(65.5%) of the injected discs showed a favorable response (pain relief greater than 3 visual analog pain scale units) to anesthetic injection. 10 out of 29 (34.5 %) did not show a favorable response. In those patients with a favorable FAD response, 19 discs showed a provocative response during discography and 18 discs showed the presence of disc pathology on CT examination. In patients with no pain relief after anesthetic injection (an unfavorable FAD response), 8 discs showed a provocative discographic response, and 6 discs showed the presence of disc pathology on CT examination.

Conclusion

FAD is a useful procedure and can be used to confirm the presence of pathologic discs as the source of a patient's low back pain symptoms.

References

Discography. Ortiz AO, Johnson B. Tech Vasc Interv Radiol. 2002 Dec;5(4):207-16.

Ortiz- Kyphon
Luchs- Kyphon