2009 ISSLS Prize Winner: Does discography cause accelerated progression of degeneration changes in the lumbar disc: a ten-year matched cohort study.

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Purpose of Study
Study Review

The 2009 ISSLS Prize Winner for the best paper was awarded to Carragee et al for the Paper Titled Does Discography Cause accelerated progression of degenerative changes in the lumbar Spine:

In this paper, Dr. Carragee followed a group of asymptomatic volunteers who had discography from L3-S1 performed in 1997,  and compared the results of their MRI’s compared to an equally matched group of subjects that did not undergo discography.  MRI’s were obtained 7-10 years post discography, and was blindly interpreted by 4 experienced readers.

Using mostly 25 gauge needles, and low pressurization, experienced discographers used modern techniques during the 1997 procedure.

Data was collected on 50 discography volunteers, and 52 matched control volunteers.

It was statistically significant that the discography volunteers had increased rates of disc degenerative findings compared to the control group.

Specifics of the study showed a greater rate of HNP, back pain, and lumbar surgery for the discography volunteers.

When this paper was first published, it brought alarm to the spine surgery community. Prior to the study, most had thought modern discography technique would not cause any significant adverse effects on healthy or normal discs.  This study suggested caution when using the discography technique, as there was potential for an iatrogenic disc condition.

In 2000, Dr. Carragee authored a paper titled Can Discography Cause Long-term Back Symptoms in Previously Asymptomatic Subjects?

In that paper, he concluded that “no subject with normal psychological profile had continued pain after discography.” At that time, the long term effects of discography was not known.

With the 2009 paper, the 2001 study conclusion is now challenged.   Continued follow-up of the study patients will provide more long term data about discography effects.    Dr. Carragee has been appropriately recognized for his scientific analysis of an at time controversial diagnostic technique.

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