Technical Considerations

Discography must be performed safely and accurately, and the results must be reproducible. To achieve these objectives, discographers must be thoroughly knowledgeable in spinal anatomy and pathology, fluoroscopic imagery, radiological equipment, and radiological/fluoroscopic projection. Most interventionists and procedurally oriented neu-roradiologists can easily adapt to the requirements of this procedure. Discography should ideally be performed with a high-resolution, multidirectional, C-arm fluoroscopic device with magnification and a tilting fluoroscopic table with a movable top. For discography in the cervical and thoracic regions, the multidirectional C-arm and movable table are requirements.15,17,18,22,28

Discitis is a serious potential complication of discography,29,31,44 which, in the author's opinion, merits the use of antibiotics unless con-traindicated owing to allergy. In the past 8 years, and in our last 8000 and counting discograms, in the absence of an allergy to either cephalosporins or penicillins (and no knowledge of prior cephalosporin use), we have routinely used an intradiscal antibiotic (Cefazolin) that covers Staphylococcus aureus.12,18 Clinical experience (not formally investigated) suggests that the risk of disc infection is reduced with the use of intradiscal antibiotics. We mix 1 g of Cefazolin in 10 mL of sterile saline with approximately 45 to 50 mL of nonionic, low osmolar contrast agent. This can also be mixed at the time of each individial case, as a mixture of 9 to 10 mL of Iohexol with 2 mL (200 mg) of Ce-fazolin. Antibiotic should not be put in the contrast if there is a chance of a dural puncture as Cefazolin will cause seizure.

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Essentials of Human Physiology

Essentials of Human Physiology

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