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Which of the following procedures has been found to lead to accelerated disc degeneration and the development of reactive endplate changes?
Lumbar transforaminal epidural steroid injections
Lumbar spinal anesthesia
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Provocative discography leads to accelerated disc degeneration and the development of reactive endplate changes.
The diagnosis and treatment of discogenic pain remains controversial. Provocative discography is the primary method to confirm the diagnosis of discogenic pain. In this procedure, contrast is injected into the nucleus pulposus in the affected disc as well as a normal adjacent levels as a control. If the injection into the affected disc reproduces pain, and the injection in the adjacent control level does not reproduce pain, the provocative discography is considered positive.
Carragee et al. performed a prospective study of disc degeneration progression over 10 years with and without baseline discography. They found discs that had been exposed to discography had greater progression of degenerative findings compared to control (noninjected) discs. Degenerative changes included new disc herniations, decreased disc height, and endplate changes.
Kim et al. used a rabbit model to evaluate the effect of puncturing the intervertebral disc annulus with different gauged needles. They found that puncturing the annulus with a needle consistently led to disc degeneration in the rabbit lumbar spine.
Illustration A shows an example of a 3 level provocative discography.
Answer 2,3,4,5: None of these procedure have been shown to directly lead to accelerated degenerative changes of the intervertebral disc.
Carragee EJ, Don AS, Hurwitz EL, Cuellar JM, Carrino JA, Carrino J, Herzog R
Spine. 2009 Oct;34(21):2338-45. PMID: 19755936 (Link to Abstract)
Carragee, SPINE 2009
Kim KS, Yoon ST, Li J, Park JS, Hutton WC.
Spine (Phila Pa 1976). 2005 Jan 1;30(1):33-7. PMID: 15626978 (Link to Abstract)
Kim, SPINE 2005
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