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J Am Acad Orthop Surg, Vol 14, No 1, January 2006, 46-55.
© 2006 the American Academy of Orthopaedic Surgeons
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Diskography in the Evaluation of Low Back Pain

Spiros G. Pneumaticos, MD, PhD, Charles A. Reitman, MD and Ronald W. Lindsey, MD

Dr. Pneumaticos is Assistant Professor, Department of Orthopedic Surgery, Baylor College of Medicine, Houston, TX. Dr. Reitman is Assistant Professor, Department of Orthopedic Surgery, Baylor College of Medicine. Dr. Lindsey is Professor and Chair, Department of Orthopedic Surgery, University of Texas Medical Branch, Galveston.

None of the following authors or the departments with which they are affiliated has received anything of value from or owns stock in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Pneumaticos, Dr. Reitman, and Dr. Lindsey.

Reprint requests: Dr. Lindsey, Department of Orthopaedic Surgery, University of Texas Medical Branch, Rebecca Sealy Hospital, 2316 University Boulevard, Galveston, TX 77555.

Diskography is evolving to play a crucial role in the evaluation of axial low back pain, especially in regard to surgical decision making. Despite advances in other forms of imaging, diskography remains unique in that it is the only test that seeks to provoke a pain response during the study. It has been suggested that patients with axial low back pain who experience a concordant pain response during diskography are more likely to respond favorably to surgical intervention. However, the efficacy of using this potential correlation is dependent on the technical application and interpretation. The validity of diskography remains controversial, in part because postdiskography surgical outcomes have been inconsistent. Therefore, in select patients with recalcitrant back pain, diskography remains a second-line diagnostic modality that is used to clarify surgical indications. Despite well-defined guidelines, the technical aspects of diskography and its interpretation are still evolving.






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