Discography MCQ Ans

1.
Specific indications for discography include all of the following,

EXCEPT
(A) further evaluation of abnormal discs to assess the extent of abnormality
(B) patients with persistent, severe symptoms in whom other diagnostic tests
have revealed clear confirmation of a suspected disc as the source of pain
(C) assessment of patients who have failed to respond to surgical procedures

to determine if there is possible recurrent disc herniation
(D) assessment of discs before fusion to determine if the discs within the
proposed fusion segment are symptomatic
(E) assessment of minimally invasive surgical candidates to confirm a

contained disc herniation or to investigate contrast distribution pattern
before intradiscal procedures
Ans: B) Patients with severe, persistent symptoms (discogenic in origin) that

have been confirmed by other diagnostic evaluations do not need to undergo
further evaluation by discography. Specific uses for discography include, but
are not limited to: further evaluation of demonstrably abnormal discs to help
assess the extent of abnormality or correlation of the abnormality with
clinical symptoms (in case of recurrent pain from a previously operated disc
and a lateral disc herniation); patients with persistent, severe symptoms in
whom other diagnostic tests have failed to reveal clear confirmation of a
suspected disc as the source of pain; assessment of patients who have failed
to respond to surgical procedures to determine if there is painful
pseudoarthrosis or a symptomatic disc in a posteriorly fused segment, or to
evaluate possible recurrent disc herniation; assessment of discs before fusion
to determine if the discs within the proposed fusion segment are
symptomatic and to determine if discs adjacent to this segment are normal;
and assessment of minimally invasive surgical candidates to confirm a
contained disc herniation or to investigate contrast distribution pattern
before intradiscal procedures.
2. Discographic stimulation (formally known as discography) is

considered positive if
(1) adjacent disc stimulation causes pain
(2) thermal stimulation with a wire electrode causes pain
(3) pain is reproduced at pressures greater than 80 psi
(4) pain is reproduced at pressures less than 50 psi and preferably less than
15 psi
Ans: (C) Despite its controversial history, disc stimulation (formerly known as
discography) remains the only means by which to determine whether or not
a disc is painful. The test is positive if upon stimulating a disc the patient’s
pain is reproduced provided that stimulation of adjacent discs does not
reproduce their pain. Discs are also considered to be symptomatic only if
pain is reproduced at injection pressures less than 50 psi and preferably less
than 15 psi. At injection pressures greater than 80 psi, some discs are painful
in normal individuals. The stimulation of discs has been complemented by
another approach, heating a wire electrode that has been inserted into a disc
annulus. Heating a disc evokes pain that is perceived in the back. This pain
may also radiate to the lower extremities and be responsible for referred pain
in the thigh and leg.
3. Positive lumbar provocative discogram for mechanical disc

sensitization includes reproduction of patient’s pain with injection
of the contrast in nucleus pulposus at what pressure above the
“opening pressure”?
(A) <30 psi
(B) < 100 psi
(C) < 10 to 15 psi
(D) <50 psi
(E) < 70 psi
Ans: (D)
A. Provocative discography is best done while pressure of contrast has been
continuously measured. Reproduction of pain at < 30 psi above the opening
pressure may represent chemical sensitization of the disc.
B. Pressures between 50 and 100 psi mean inconclusive results.
C. Pressures of 10 to 15 psi are more consistent with the opening pressure. It

represents the pressure at which the contrast is first seen in the nucleus
pulposus.
D. Reproduction of pain at < 50 psi above the opening pressure may

represent mechanical sensitization of the disc. During provocative
discography, besides pressure measurements, pain levels should be > 6/10
and pain location and quality should be similar to the chronic low back pain.
4. The technique of cervical discography includes needle entry

through the skin from the
(A) anterior right side of the neck
(B) posterior right side of the neck
(C) anterior left side of the neck
(D) posterior left side of the neck
(E) median posterior side of the neck
Ans: (A) Cervical discography is performed with patient in supine position,

using oblique approach, similar to the stellate ganglion block. The esophagus
is normally positioned slightly toward the left side of the neck. To prevent
puncturing it, the best technique for needle insertion for cervical discography
is anterior right-sided approach.
5. When performing lumbar discography, the “opening pressure” is

the recorded pressure signifying
(A) first appearance of the contrast in nucleus pulposus
(B) opening of the annular tear to the contrast

(C) reproduction of concordant pain
(D) resting pressure transduced from the nucleus
(E) a dural leak
Ans: (A)
A. The opening pressure is always subtracted from pressure reproducing pain

in final calculations (eg, positive discography means: pressure with pain
reproduction— opening pressure < 50 psi).
B. First appearance of contrast in annular tear usually coincides with the

reproduction of pain.
C. Reproduction of concordant pain means positive discography at tested

level.
D. Resting pressure measurements is not used for interpretation of

provocative discography.
6. When performing lumbar discography, in relation to the laterality

of pain, which of the following should be the needle entry site?
(A) Ipsilateral
(B) Contralateral
(C) Laterality does not make a difference
(D) Guided by MRI images
(E) None of the above
Ans: (C) It does not seem that the outcomes of discography are affected by
laterality of needle insertion site.

Discography MCQ Ans

Uploaded by

Copyright:

Available Formats

Discography MCQ Ans

Uploaded by

Document Information

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Discography MCQ Ans

Uploaded by

Copyright:

Available Formats

1.

Specific indications for discography include all of the following,

(A) further evaluation of abnormal discs to assess the extent of abnormality

(C) assessment of patients who have failed to respond to surgical procedures

(E) assessment of minimally invasive surgical candidates to confirm a

Ans: B) Patients with severe, persistent symptoms (discogenic in origin) that

2. Discographic stimulation (formally known as discography) is

(2) thermal stimulation with a wire electrode causes pain

(3) pain is reproduced at pressures greater than 80 psi

3. Positive lumbar provocative discogram for mechanical disc

(A) <30 psi

(B) < 100 psi

(C) < 10 to 15 psi

(D) <50 psi

(E) < 70 psi

B. Pressures between 50 and 100 psi mean inconclusive results.

C. Pressures of 10 to 15 psi are more consistent with the opening pressure. It

D. Reproduction of pain at < 50 psi above the opening pressure may

4. The technique of cervical discography includes needle entry

(A) anterior right side of the neck

(B) posterior right side of the neck

(C) anterior left side of the neck

(D) posterior left side of the neck

(E) median posterior side of the neck

Ans: (A) Cervical discography is performed with patient in supine position,

5. When performing lumbar discography, the “opening pressure” is

(A) first appearance of the contrast in nucleus pulposus

(B) opening of the annular tear to the contrast

(D) resting pressure transduced from the nucleus

(E) a dural leak

A. The opening pressure is always subtracted from pressure reproducing pain

B. First appearance of contrast in annular tear usually coincides with the

C. Reproduction of concordant pain means positive discography at tested

D. Resting pressure measurements is not used for interpretation of

6. When performing lumbar discography, in relation to the laterality

(C) Laterality does not make a difference

(D) Guided by MRI images

(E) None of the above

You might also like