Is Discography Associated with a Higher Rate of Re-operation for Disc-related Pain 10 to 20 Years Later?

Abstract

This was a retrospective study with patient contact attempted to collect current follow-up data. The purpose of this study was to compare rates of disc-related surgery during long-term follow-up in discs that underwent discography versus those that did not. Some studies reported discography causes normal discs to degenerate due to the needle puncture and/or the injectate. However, other studies suggest discography does not damage discs. Data collected for 196 patient included descriptives, discography information, and re-operation details. Only patients with minimum 10-year follow-up (mean 152.9 mo, range 120-247) were included. Data were analyzed by disc level. Included levels were: L3-4, L4-5, L5-S1, or L2-3 or L1-2 that underwent discography or were adjacent to an operated level. Discs were excluded if they had undergone an interbody procedure. The study included 244 discs that received discography and 122 discs that did not. Rates of surgery for disc degeneration or herniation after the index surgery were compared in these two groups. Re-operation rates for disc-related pain was not greater among discs that underwent discography vs. those that did not (10.2% vs. 8.3% P>0.50). Forward conditional regression analysis found the factor most strongly related to disc-related re-operation was the discogram results (not simply having a discogram). The only other variable significantly related to re-operation was the individual lumbar level. Age, body mass index, sex, or having a discographic injection were not related to subsequent disc-related surgery. Surgery rates for disc-related pathology were similar for discs not receiving discography (8.3%) and those that were discographically normal (5.2%). These were both significantly less than the 18.8% among discs not normal on discography. There was no significant difference in disc-related surgery rates based on discographic injection. These findings support that discographic injection does not injure normal discs.