MRI DISCOGRAPHY vs INVASIVE DISCOGRAPHY FOR LOCALISATION OF DISCOGENIC BACK PAIN

MRI Discography, also known as MRI Disc Spectroscopy, is an emerging non-invasive MRI technique which allows spectroscopic analysis of the biochemical composition of intervertebral discs using advanced MRI techniques and specialised software. Studies have demonstrated a high correlation between non invasive MRI Disc Spectroscopy and conventional Invasive Provocative Discography.

MRI Disc Spectroscopy allows spectral analysis of a disc to quantify the breakdown of numerous biomarkers including collagen, proteoglycan, lactate, alanine and relative acidity. Key biomarkers indicating disc degeneration and pain include the breakdown of structural matrix elements such as collagen and proteoglycans, and a high proportion of painful acids such as Lactate.

Conventional invasive Provocative Discography is an interventional procedure first performed in 1941, involving imaging guided injection of a disc with contrast to determine if discogenic back pain is reproduced at a specific level, and to define intradisc anatomy. The procedure is used to aid localisation of discogenic pain and as an aid to surgical planning. Provocative Discography is often accompanied by significant patient discomfort, despite liberal use of anaesthesia and conscious sedation, and carries the risk of various complications including nerve root injury and discitis.

A 2019 study published in the European Spinal Journal (Gornet et al) compared the results of MRI Disc Spectroscopy with invasive Provocative Discography in 275 lumbar intervertebral discs.

MRI spectroscopy was used to measure the key biomarker composition including acidity ratios to calculate an overall MRS-SCORE, graded 0 to 10, indicating the probability of discogenic pain at that level.

The study demonstrated a high correlation between a high MRI Disc Spectroscopy MRS-SCORE and a positive Provocative Discogram, including 85% accuracy, 82% sensitivity and 88% specificity.

Post operatively, at 6-12 months following surgical management, MRS +ve discs treated surgically had a high correlation with a successful outcome (>90%), and conversely MRS -ve discs treated surgically had a low correlation with a successful outcome (around 50%).

Key Points

  • Overall, emerging research suggests that MRI Discography (MRI Disc Spectroscopy) is a promising safe, painless, and non-invasive alternative to conventional invasive Provocative Discography, which is often painful and associated with a number of procedural risks.
  • MRS has a high correlation with Provocative Discography (85% overall accuracy) in the localisation of the source of discogenic back pain.
  • MRS +ve discs treated surgically have a high post operative success rate (>90%).
  • MRS -ve discs treated surgically have a comparitively low post operative success rate (approx 50%).

Ref : “Magnetic Resonance Spectroscopy (MRS) can identify painful lumbar discs and may facilitate improved clinical outcomes of lumbar surgeries for discogenic pain” ; G. Gornet, J. Peacock, J. Lotz et al; European Spinal Journal; 2019.

Panorama Radiology Specialists offer MRI Discography (MRI Disc Spectroscopy) to aid localisation of discogenic lower back pain.

PRS process MRS data inhouse in collaboration with our UQ research team. We do not send MRS cases to the USA for data processing, which may be the case in other centres.

PRS accept all MRI Discography referrals.

I’m always happy to discuss individual cases with referring clinicians – if you’re a medical practitioner seeking an opinion on which imaging-guided pain management measures may be most appropriate and beneficial in an individual clinical situation, please feel free to contact me directly.

Dr Angus Watts

MBBS, FRANZCR

Diagnostic and Interventional Radiologist

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