Lumbar discography: Diagnostic role in discogenic pain

Although modern imaging techniques such as magnetic resonance imaging and computed tomography are useful in detecting anatomic abnormalities within the intervertebral disc, they cannot provide any information regarding the presence or absence of pain arising from anatomic abnormalities. Discography is currently the only diagnostic method that is available to determine whether an anatomically abnormal intervertebral disc is the cause of a given patient's ongoing pain. However, discography is a subjective test, relying entirely on the patient's pain experience during the conduct of this brief procedure, which is without effective controls. This article discusses the current scientific evidence regarding the use of discography at lumbar spinal levels, describes the technique and associated complications, and explores the controversies surrounding the usefulness of this diagnostic test.