Is there a role for diskography in the era of magnetic resonance imaging? Prospective correlation and quantitative analysis of computed tomography-diskography, magnetic resonance imaging, and surgical findings.

Abstract

We herein report the results of a prospective study to define the role of diskography in the diagnosis of low back pain in an emerging era of magnetic resonance imaging (MRI). The study involved 32 patients (78 disks) with a clinical diagnosis of lumbar disk herniation; all were studied by computed tomography-diskography (CT-D), and 25 (51 disks) were also examined using MRI. The disks were graded on these studies according to a staging scheme modified from Modic. Ten of the patients (13 disks) having both CT-D and MRI underwent exploratory surgery, and the staging at surgery served as the standard against which the evaluative studies were judged. Surgical staging was compatible with the CT-D and MRI results in five disks, while in another five disks it was compatible only with the CT-D results. In the remaining three disks, both CT-D and MRI misidentified the stages. In six disks, CT-D more accurately defined the stage of disease than did MRI, whereas MRI was more precise than CT-D in only one disk. While having documented the value of CT-D as a source of information, particularly when surgery is contemplated, and as an effective means of staging disk herniation, we recommend MRI as the ideal screening test for lumbar radiculopathy and low back pain, reserving diskography for problematic cases.