Provocative discography as predictor of discogenic pain and therapeutic outcome

The use of provocative discography (discography) in diagnosing degenerative disk disease and predicting surgical outcomes is a subject of ongoing debate. Magnetic resonance imaging and computed tomography are the preferred methods for visualizing disk morphology. While these advanced imaging studies produce a superior anatomical assessment and can identify surgically correctable lesions, discography is the only available method to determine whether an abnormally appearing disk is also painful. Discography is a subjective test, relying entirely on the patient's description of pain during the procedure. Therefore, controversies and concerns for its diagnostic accuracy and validity have been abundant since the technique was first described. Due to the perplexing problem of evaluating and treating chronic low back pain, discography is still considered by many to provide useful information in planning the surgical management of spinal pain from discogenic disease. This article presents a general overview of lumbar discography and the current state of evidence for its use in predicting treatment outcomes.