Devoted to diagnostic and interventional spine imaging and therapeutics


Provocation Lumbar Diskography at Previously Fused Lumbar Levels 2008

Interventional Spine

Harjot S Dulai, MD
Walter S Bartynski, MD, ASSR Member
William E Rothfus, MD, ASSR Member

Scientific Paper


To assess the provocation diskogram results and clinical value of performing provocation lumbar diskography at previously fused lumbar levels.

Methods & Materials

Over a three year period, 29 patients with prior lumbar fusion were identified who underwent provocative diskography and these cases were retrospectively reviewed.
In 20 patients, residual pain similar to their previously treated back pain persisted and diskography included testing of the previously fused levels. In 9 patients, only levels adjacent to the previous lumbar fusion were studied.
Twenty four post-fusion levels were studied in the 20 patients. Diskography results were evaluated and follow up assessed including subsequent surgical revision.


Twelve of 24 (50%) previously fused levels demonstrated a positive and concordant pain response at diskography. Of the remaining 12 previously fused levels, 9 were negative and 3 demonstrated non-concordant pain.
Adjacent level concordant pain was also demonstrated in 9 total patients-3 in patients with positive concordant fused levels, 4 in patients with negative fused levels, and 2 in patients with non-concordant fused levels.
Surgical revision was performed at the previously fused level in 6 patients, all of which had demonstrated concordant pain during diskography. In three of these patients, additional inter-body fusion was also performed at an adjacent disc levels. Four fused levels demonstrated diskographic contrast leakage.
Inter-body fusion was also performed at an adjacent level in two patients with negative response at the previously fused level.
Overall, surgical revision was performed in 8 patients, of which 6 had concordant fusion level pain. The two patients without concordant fusion level pain had surgery at adjacent levels only.


Pain can be identified by provocation lumbar diskography at previously fused lumbar levels and these are commonly surgically revised. Adjacent level provoked pain is not uncommon, and these levels may also undergo a primary operation or be included in a surgical revision.


No relationships to disclose.