Discography-induced acute lumbar disc herniation: a report of five cases.
The reported complication rate of provocative lumbar discography is low, ranging from 0-2.5%. We report five cases of acute lumbar disc herniation precipitated by discography, a previously unreported complication. The cases reported comprise of four men and one woman with ages ranging from 23-45 years. All developed an acute exacerbation of radicular leg pain following multilevel provocative lumbar discography. One patient developed an acute foot drop. Comparison of lumbar MRI scans before and after discography demonstrated either a new herniated disc fragment or an increase in size of a preexisting herniation in all cases. On review of each discogram study and pre-discogram MRI an annular tear or small disc herniation was noted in all cases. In each case the patients' symptoms failed to resolve necessitating surgical intervention in all cases. In conclusion, annular deficiency is an obvious predisposing factor to discogram related disc herniation. New onset or a persistent exacerbation of radicular symptoms following provocative discography merits further investigation.
Poynton
Ashley R
AR
Department of Spinal Surgery, Hospital for Special Surgery, New York, NY, USA. ashpoynton@aol.com
Hinman
Adrian
A
Lutz
Gregory
G
Farmer
James C
JC
D000208:Acute Disease; D000328:Adult; D001175:Arthrography / Q000009:adverse effects*; D003287:Contrast Media / Q000009:adverse effects*; D005260:Female; D020233:Gait Disorders, Neurologic / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D006874:Hydrostatic Pressure / Q000009:adverse effects; D007403:Intervertebral Disc / Q000000981:diagnostic imaging* / Q000293:injuries* / Q000473:pathology; D007405:Intervertebral Disc Displacement / Q000000981:diagnostic imaging* / Q000209:etiology* / Q000473:pathology; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology; D012585:Sciatica / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology; D013115:Spinal Canal / Q000000981:diagnostic imaging / Q000473:pathology; D013126:Spinal Nerve Roots / Q000293:injuries / Q000473:pathology / Q000503:physiopathology
D003287:Contrast Media