Awake Discography

This study was undertaken to determine the correlation between awake discography findings and magnetic resonance imaging in the evaluation of symptomatic lumbar disc disease. The study included 164 consecutive patients who underwent evaluation with discography and magnetic resonance imaging for lumbar disc disease from August 1987 to September 1989. Chronic low-back pain, with or without radicular symptoms, was the presenting complaint in each case. Each patient had previously failed conservative treatment. The average age was 36 (range, 19-66 years). Magnetic resonance images were performed before discography in each case. Discography was performed with patients minimally sedated and under local anesthesia. A lateral approach was used. Magnetic resonance imaging and discography correlated in 90 cases (55%) and differed in 74 (45%). Considering disc levels, discography and magnetic resonance imaging correlated in 371 discs (80%). There were 172 normal discs and 199 abnormal discs. Of the abnormal discs, 151 (76%) reproduced symptoms. In 60 discs (13%), magnetic resonance images showed abnormal findings and the discogram normal findings. Discs levels classified as abnormal on magnetic resonance imaging demonstrated that 108 discs (37%) were asymptomatic. Magnetic resonance imaging showed normal findings and the discogram abnormal findings in 34 discs (7%), of which 21 (5%) recreated exact symptoms and 13 (2%) caused no pain. Magnetic resonance imaging is a static test and discography the only available dynamic test for disc evaluation. Awake discography is a diagnostic study that can determine which abnormal discs are symptomatic via the pain response.