I got back from Germany very late last night.... still exhausted.
Cervical discography is much like lumbar discography, but seems to be easier on the patient. My guess is because for those of us with lumbar discogenic pain, the pain is extreme. We have cervical discogenic pain, but I don't think it typically manifests itself with the severe axial back pain that the lumbies experience. (Less weight... lower pressures?) I also believe that the cervical discs are so much easier to reach that there is much less 'fiddle factor' and less pain generated during needle placement.
Interpretation of discography results is difficult for the same reasons... "Yes, it's painful, but is that your pain?" "Well... kind of, sort or like maybe." I've seen very clear results and also ambiguous results.
Like lumbaer, they pay attention to the dispersion pattern of the contrast material and also to the extravasation of the contrast out into the canal area. With much smaller spaces involved, it seems that the value of the flouroscopic images with contrast in the canal area is often more valuable than what I've seen in lumbar discography.
We usually think of discography as a provocative test that attempt to recreate an awake patient's pain. Many times I've seen interoperative cervical discography performed under general anesthesia during surgery. There is no opportunity here for pain responses. As mentioned above, the extravasation of the contrast into the epidural space provides valuable imaging. I believe that with the smaller spaces involved, posterior decompression and removal of posterior osteophytes is very critical. This 'epidurography' thats generated as a byproduct of the discogram helps a great deal.
As with lumbar discography, I don't believe it's completely risk free, so for myself, I would not submit to discography unless I was ready to act on the results. In most cases I've seen, discography is not used to determine if surgery is needed... it's used to determine how much surgery... which levels. If that's the case and your surgeon is one of those who will perform his own discography, I believe that the value of the discography performed by the surgeon is greater than the value of discography done by someone else.
I hope this helps. Remember... I'm a layperson... listen to my opinions at your own risk.
Mark
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