The diagnostic inaccuracy of the pain response in cervical discography

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THE injection of an intervertebral disk with radiopaque contrast medium, and the evaluation of the pain associated with injection constitute a diagnostic procedure known as discography. The status of the injected disk can be evaluated from the roentgenographic record thus obtained; the character and location of any pain produced on injection is believed to furnish similar information.1, 2 The value of pain production at the time of discography in the diagnosis of the lumbar intervertebral disk is well founded.3 However, the diagnostic accuracy of the cervical discogram is controversial, and the significance of the pain response is particularly indeterminate.4

An analysis was made of the pain responses to 549 cervical disk injections performed at the Cleveland Clinic Hospital in the period from 1958 through 1967. The responses to injection were considered with reference to the roentgenographic records obtained. The purpose of our study was to determine whether there was or was not a correlation between subjective response and discographic evidence.


Discography was performed with each patient supine. A subcutaneous injection of 1 percent procaine hydrochloride was administered. Deep digital pressure was applied over the appropriate interspace between the trachea and the carotid artery. One of two methods was then used. The preferred method was as follows. A 2-in. 20-gauge spinal guide needle was inserted into the outer annulus of the appropriate intervertebral disk, and a 2½-in. 26-gauge spinal needle was passed through this guide needle toward the center of the disk. Central placement of the needle was always the . . .



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