The role of intervertebral discography and post-contrast CT examination in the diagnosis of lumbar disc herniation and responsible intervertebral discs in patients with low back and leg pain

Objective To apply lumbar discography combined with CT thin layer scanning in the diagnosis of lumbar disc herniation and responsible segment of the intervertebral discs in patients with low back and leg pain. Methods One hundred and twenty patients with low back and leg pain were selected, from March 2015 to May 2018 in Spine Department of Kunming Orthopaedic Hospital. CT showed that there was no obvious disc herniation, or multiple segments herniation, single segmental punctate herniation or one segment of suspicious herniation, and unclear responsibility intervertebral disc in all patients. Discography combined with CT thin layer scanning were performed to diagnose lumbar intervertebral disc herniation and the responsible segmental intervertebral disc. Finally, the responsible disc received operation. Visual analogue scale (VAS) was recorded before the operation and 24 h, 6 months after the operation. Results Four patients were excluded because of operative contraindications. Lower limb pain was duplicated by contrast radiography agent injection in 98 cases of all 116 patients received discography. The imaging manifestations of nerve root compression at the leakage site of CT thin layer scanning contrast medium with the appearance of duplicating painful segments of lower limb pain during injection is consistent in 90 cases, then the diagnosis of lumbar disc herniation and the responsible segmental intervertebral disc were clearly confirmed conformed. The operative treatment of the responsible segmental disc was performed. Compared with pre-operation, VAS was significantly decreased at 24 h and 6 months after the operation[(8.72±1.28) vs. (0.80±0.15), (8.72±1.28) vs. (2.00±0.50)]respectively (P<0.05). And all postoperative VAS was less than 3. Other 26 patients were excluded diagnosis of lumbar disc herniation. Conclusion For patients with low back and leg pain who are unable to determine whether they have lumbar disc herniation or which segment is responsible for the disc herniation, CT thin layer scanning after discography is a feasible method to confirm the diagnosis. Key words: Tomography, spiral computed; Intervertebral disc; Intervertebral discography