CT Scan and Discographic Findings in Ruptured Lumbar Discs

ABSTRACT

The herniated lumbar intervertebral disc, a common affliction in man, had been diagnosed with myelogram and treated with laminectomy. Recently, the application of CT scan and chemonucleolysis markedly changed the mode of management in lumbar disc diseases. High resolution CT scan of lumbar spine became the most popular diagnostic tool to detect herniations of lumbar discs and discolysis with chymopapain an alternative to surgery in a large number of patients. We performed CT scan and discography in 131 discs of 100 patients prior to chemonucleolysis and there were too many ruptured discs not found on CT scan but discography. Of the 5 patients who failed in chemonucleolysis severe dye leakage was seen in 4 cases. Extradural leakage of contrast medium was not a contraindication to the injection of chymopapain. However, when this occured the precaution was taken of injecting more quantity of chymopapain slowly. This report presents our experience with lumbar discography and comparative analysis of CT scan and discography. We think discography is very important diagnostic tool to detect rupture of discs prior to chemonucleolysis and may aid our gradually increasing understanding of the pathophysiology of the disc diseases.