Discography: over 50 years of controversy.

Low back pain is estimated to affect 80% of the general population at least once in their lifetime. It is the fifth leading cause of medical clinic visits and the leading work-related disability. Lumbar discography has been used to diagnose the source of low back pain when non-invasive imaging, such as magnetic resonance (MR), does not reveal morphologic abnormality consistent with symptoms. Controversy regarding the usefulness of discography has been ongoing for over 50 years. Modern advancements with imaging and technique still have not been sufficient to justify the practicality of this procedure for standard use. Based on review of current literature, pain provoked by discography of normal appearing discs on MR were likely due to internal disc disruption, increased pain sensitivity, and false positive result with chronic pain, psychological state, central hyperalgia, and technical difficulty of the procedure. These causes of positive pain provocation are not amendable to invasive treatment. In these cases, an invasive diagnostic procedure to identify problems best treated with conservative management is not practical. The conclusion of this review found no clear evidence-based purpose for discography in the diagnosis and treatment of low back pain.