Episode # 68 • 04 Feb 2025
BackTable Basics: Lumbar Disc Access & Discography
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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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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More about this episode
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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