Discography of lumbar discs after surgical treatment for disc herniation

Study Design. Eighty-three patients were identified who had discography performed at a disc level that had been subject to previous laminectomy and partial discectomy, and who had also undergone discography at one or more additional levels. The results of these studies were retrospectively reviewed. Objective. To define the results of discography performed on previously operated discs. Summary of Background Data. It is not uncommon for the physician to encounter patients with complaints of persistent chronic back pain after surgical treatment of a lumbar disc herniation. Although such patients are frequently studied by discography, there is very little scientific literature to document the expected results. Methods. A retrospective study of the results of discography on previously operated discs was performed. Results. A positive pain response was significantly more likely in the previously operated discs than in the unoperated discs (P < 0.0001). Posterior extravasation of dye was noted in 34% (35 of 102) of the postoperative discs and 21% (29 of 136) of the unoperated discs. Positive concordant pain provocation was noted in 48 (75%) of the 64 discs showing posterior dye extravasation; 28 were postoperative discs and 20 were unoperated discs. Conclusions. Patients presenting with disabling back pain who had previously undergone surgical treatment for a herniated nucleus pulposus show a high (72%) incidence of concordant pain with discography of the previously operated level. Only 34% of the previously operated discs demonstrated posterior extravasation of discography dye. Persistence of a posterior anular defect was associated with a higher incidence of positive concordant pain response.