TAILIEUCHUNG - Spinal Disorders: Fundamentals of Diagnosis and Treatment Part 30

Spinal Disorders: Fundamentals of Diagnosis and Treatment Part 30. Spinal disorders are among the most common medical conditions with significant impact on health related quality of life, use of health care resources and socio-economic costs. Spinal surgery is still one of the fastest growing areas in clinical medicine. | 272 Section Patient Assessment Table 5. Indications for provocative discography Differentiation of symptomatic and asymptomatic disc alterations Disc degeneration Annular tears high intensity zones Endplate changes modic changes Minor disc protrusions with questionable nerve root compromise Inject an MRI normal disc as a negative control Technique Discography should be performed by a spine specialist or a dedicated radiologist with experience of the diagnostic assessment of spinal disorders. It is mandatory that the patient is awake during the procedure to allow for communication about the injection response. However mild sedation is helpful during the procedure. Pain provocation should be graded as concordant or non-concordant Discogenic pain is based on the provocation of concordant pain Lumbar Discography In lumbar discography the posterolateral approach is widely accepted as the technique of choice. A double needle technique with a short 18-gauge external and an internal 22-gauge needle is widely recommended 48 116 . In patients with unilateral pain the needle is introduced from the contralateral side to distinguish between iatrogenic and genuine pain. The needle position is verified under fluoroscopy in two planes. After accurate needle positioning contrast medium containing an iodine concentration of 300 mg ml is injected into each disc by using a 5-ml syringe. The amount of contrast agent injectable before leakage usually ranges from ml to ml before leakage 10 . Non-ionic contrast agent is injected with a 5-ml syringe until firm resistance to the injection is felt until severe pain is provoked or until contrast medium is seen to leak out of the disc into the spinal canal. During discography the patient is asked to grade the pain provoked on a visual analogue scale. The type of pain should be graded according to the Dallas Discogram Description 97 as follows no sensation pressure dissimilar pain similar pain or exact pain reproduction Pain sensation .

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