Low back pain is the second most common reason for patients to seek medical attention. The cost of care for low back pain is approximately $200 billion a year. A wide range of medical specialists including neurosurgeons, orthopedic surgeons, radiologists, neurologists, internists, family physicians, physiotherapists, and psychiatrists are involved. The scope, frequency, and complexity of this medical problem has led to paramedical specialties, such as chiropractice, and desperate patients who are disappointed from medical and surgical treatment may even resort to acupuncture and other types of alternative medicine. Physicians have exhausted many diagnostic modalities for identifying the multifactorial etiologies of low back pain. These include plain radiographs, myelography, epidural venography, epidural and nerve block, CT, MR imaging, CT myelograms, contrast-enhanced MR imaging, discograms, facet block, electromyography, and thermography.

Plain radiography has the advantage of showing morphology of the spine, such as congenital anomalies; scoliosis; bone density; alignment of the spine; soft tissue changes, such as renal stones or aneurysm of the aorta or aortic calcification; disc space; facet joint; osteophytes; and pars interarticularis defects. Tomographic modalities, such as CT and MR imaging, are used when the patient is unresponsive to conservative therapy or has neurologic deficits. CT has the advantage of showing bony disease including fractures, pseudoarthrosis, facet degeneration, osteophytes, spinal stenosis, and postoperative stenosis. MR imaging is helpful when concern is disc disease or for postsurgical changes and evaluation of tumor and metastases. Although CT and MR imaging are useful modalities in the investigation of radicular pain, they offer little in the evaluation of back pain and somatic-referred pain.<sup>9 Bogduck N., Modic M. Controversy lumbar discography Spine 1996 ;  21 : 402-404

Cliccare qui per andare alla sezione Riferimenti</sup> Discography is a provocative test that has a useful but limited position in the low back pain management armamentarium. Mooney<sup>70 Mooney V. Lumbar discography Spine 1996 ;  21 : 1479  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti</sup> calls discography a “useful, but less than perfect, diagnostic study.” Guyer et al<sup>43 Guyer R.D., Ohnmeiss D.D. Contemporary concepts in spine care: Lumbar discography Spine 1995 ;  20 : 2048-2059  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti, 44 Guyer RD, Ohnmeiss DD, Hochschuler SH, et a1 The use of CT/discography to identify recurrent disc herniation not visualized by gadolinium-en hanced MRI. Presented at the Federation of Spine Association, Anaheim, California, March, 1991

Cliccare qui per andare alla sezione Riferimenti</sup> called discography the only method that directly relates a radiographic image to the patient's pain. Selby et al<sup>83 Selby D.K., Henderson R.J., Blumenthal S., Dossett D. Anterior lumbar fusion Lumbar Spine Surgery. St. Louis: CV Mosby (1987).  384

Cliccare qui per andare alla sezione Riferimenti</sup> recognized discography as the only modality that can detect internal disc disruption syndrome. Although originally introduced as a technique for the study of disc herniation, discography is mainly used for its pain provocation to determine the source of the patient's pain.<sup>9 Bogduck N., Modic M. Controversy lumbar discography Spine 1996 ;  21 : 402-404

Cliccare qui per andare alla sezione Riferimenti</sup> According to Bernard et al's<sup>4 Bernard T.N. Don't discard discography Radiology 1987 ;  162 : 285

Cliccare qui per andare alla sezione Riferimenti, 7 Bernard T.N., Kirkaldy-Willis W.H. Making a specific diagnosis Managing Low Back Pain New York: Churchill-Livingstone (1988).  209-227

Cliccare qui per andare alla sezione Riferimenti</sup> definition, discography is a physiologic evaluation of the disc consisting of a volumetric, manometric, radiographic, and pain-provocative challenge. Although some clinicians believe that discography helps to identify conditions, such as internal disc disruption, and to verify painful disc levels in anticipation for surgery, others find the test unproven and of questionable benefit. From its original inception time until today, discography gained and lost popularity several times. The proponents of this technique refer to the literature, which is replete with articles counting the benefit and efficacy of discography, and praise it as the only pain-provocative test available for investigation of back pain and somatic-referred pain. Opponents of this procedure, like Shapiro,<sup>84 Shapiro R. Lumbar discography: An outdated procedure J Neurosurg 1986 ;  64 : 686-691

Cliccare qui per andare alla sezione Riferimenti</sup> call it an outdated procedure, and Nachemson<sup>72 Nachemson A. Lumbar discography: Where are we today? Spine 1989 ;  14 : 555-556  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti</sup> and Bogduck and Modic<sup>9 Bogduck N., Modic M. Controversy lumbar discography Spine 1996 ;  21 : 402-404

Cliccare qui per andare alla sezione Riferimenti</sup> believe that discography must be submitted to strict scientific and prospective evaluation, and until then there is no basis for the performance of discography in clinical medicine.