The lumbar discogram is a cornerstone of musculoskeletal (MSK) radiology, as it enables interventionalists to pinpoint the exact level of discogenic back pain. In this episode of Backtable MSK, the Dr. Olivier Clerk-Lamalice and host Dr. Jacob Fleming explore the techniques and applications of the discogram, a procedure highly valued for its effectiveness in both diagnosis and pain management.

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This podcast is supported by:

Medtronic Interventional

https://www.medtronic.com/interventional

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SYNPOSIS

They discuss the fluoroscopically guided approach, focusing on techniques like Kambin’s triangle and the far-lateral approach. The doctors also cover their preferred contrast agents and injection methods, along with concurrent therapeutic injections.

The conversation delves into the varied disc anatomies that require different approaches, including adjustments in needle angulation. They also emphasize the importance of prophylactic antibiotics, potential challenges, and the evolving landscape of therapeutic options, including intradiscal platelet-rich plasma (PRP) and bone marrow aspirate concentrate (BMAC).

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TIMESTAMPS

00:00 - Introduction

01:17 - Overview of Lumbar Discogram Technique

04:56 - Contrast Injection and Pain Response

07:40 - Therapeutic Injections

10:00 - Discography Under CT Guidance

12:43 - Strategies for Challenging Cases

17:52 - Protocol for Infection Prevention

20:15 - Post-Discogram Treatment Options

21:30 - Emerging Therapies

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RESOURCES

BackTable MSK Ep. 68- Introduction to the Treatment of Discogenic Back Pain:

https://www.backtable.com/shows/msk/podcasts/67/introduction-to-treatment-of-discogenic-back-pain

BackTable MSK Ep. 62- Exploring Intradiscal PRP for Back Pain Relief with Dr. Guilherme Ferreira Dos Santos:

https://www.backtable.com/shows/msk/podcasts/62/exploring-intradiscal-prp-for-back-pain-relief