Is Discography Associated With a Higher Rate of Reoperation for Disk-Related Pain 10 to 20 Years Later?

STUDY DESIGN: This was a retrospective study with patient contact attempted to collect current follow-up data. OBJECTIVE: The purpose of this study was to compare rates of disk-related surgery during long-term follow-up in disks that underwent discography versus those that did not. SUMMARY OF BACKGROUND DATA: Some studies reported discography causes normal disks to degenerate due to the needle puncture and/or the injectate. However, other studies suggest discography does not damage disks. MATERIALS AND METHODS: Data collected for 196 patients included descriptives, discography information, and reoperation details. Only patients with a minimum 10-year follow-up (mean: 152.9 mo, range: 120-247) were included. Data were analyzed at the disk level. Included levels were: L3-4, L4-5, L5-S1, or L2-3 or L1-2 that underwent discography or were adjacent to an operated level. Disks were excluded if they had undergone an interbody procedure. The study included 244 disks that received discography and 122 disks that did not. Rates of surgery for disk degeneration or herniation after the index surgery were compared in these two groups. RESULTS: Reoperation rates for disk-related pain were not greater among disks that underwent discography versus those that did not (10.2% vs. 8.3% P >0.50). Forward conditional regression analysis found the factor most strongly related to disk-related reoperation was the discogram results (not simply having a discogram). The only other variable significantly related to reoperation was the individual lumbar level. Age, body mass index, sex, or having a discographic injection were not related to subsequent disk-related surgery. Surgery rates for disk-related pathology were similar for disks not receiving discography (8.3%) and those that were discographically normal (5.2%). These were both significantly less than the 18.8% among disks not normal on discography. CONCLUSION: There was no significant difference in disk-related surgery rates based on discographic injection. These findings support that discographic injection does not injure normal disks.