HealthDay News –  The disc puncture and pressurized injection performed during invasive provocative discography testing is associated with increased risk of clinical disc problems, according to a study published in The Spine Journal.

Recent studies have shown radiographic disc degeneration on magnetic resonance imaging (MRI) 10 years after patients underwent provocative discography testing. However, the clinical effects of such radiographic evidence of disc degeneration after the invasive test had not been systematically examined. 

To examine the clinical effects of lumbar provocative discography, Jason M. Cuellar, MD, PhD, from the Cedars Sinai Medical Center in Los Angeles, and colleagues conducted a prospective, 10-year matched cohort study. 

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Seventy-five patients without current low-back pain problems were recruited; a closely matched control cohort was simultaneously recruited to undergo a similar evaluation. Participants were followed by serial protocol evaluations at one, two, five, and 10 years after enrollment.

The researchers found that 71 discography and 72 control subjects completed baseline evaluation, and 57 and 53, respectively, completed all interval surveillance assessments. There were 16 and four lumbar surgeries in the discography and control groups, respectively. The discography group also more frequently had medical visits, computed tomography(CT)/MRI, work loss, and prolonged back pain episodes compared with controls.

Summary and Clinical Applicability

In study participants who underwent invasive provocative discography evaluations, medical visits, CT/MRI examinations, work loss, and prolonged back pain events were all more frequently observed as compared to participants who did not undergo discography.

“The disc puncture and pressurized injection performed during provocative discography can increase the risk of clinical disc problems in exposed patients,” the authors write.

Limitations and Disclosures

By nature of the prospective cohort study design, this study was susceptible to effects from differential loss of followup.  

Several authors disclosed financial ties to the pharmaceutical and biotechnology industries.


Cuellar JM, Stauff MP, Herzog RJ, Carrino JA, Baker GA, Carragee EJ. Does provocative discography cause clinically important injury to the lumbar intervertebral disc? A 10-year matched cohort study. Spine J. 2016;16(3):273-80.