• Matthew Smuck, Timothy Yoon, and Miles Colwell.
• The Spine Program, Department of Physical Medicine and Rehabilitation, University of Michigan Hospitals, Ann Arbor, Michigan 48170, USA. msmuck@med.umich.edu
• Pain Med. 2008 Nov 1;9(8):1030-4.

ObjectiveReport a case of intravascular contrast injection during lumbar discography.SettingAn academic University spine center.PatientForty-year-old woman with L5-S1 degenerative disk disease and persistent low back pain.InterventionThe patient failed to respond to multiple conservative treatments. In consideration of surgical treatment, discography was requested.ResultsA 22G needle was inserted to the central nucleus by a left posterolateral approach. Discography was performed at L4-5 and L5-S1. Testing was performed with pressure manometry, beginning with the L4-5 disk. The pressure increased with contrast injection in the manner of a normal disk. At 45 psi there was a sudden drop to 20 psi. Lateral views obtained during contrast injection demonstrated flow from a central nucleogram cephalad into the anterior epidural space. Images obtained with live fluoroscopy demonstrated a vascular flow pattern, confirmed with lateral and anterior-posterior views. The needle tip was repositioned anterior and superior. Repeat injection resulted in an identical vascular pattern. From the time the pressure dropped, contrast flowed in the vascular pattern without propagation of the nucleogram or increase in intradiscal pressure. The patient was asymptomatic throughout the injection at L4-5. Injection at L5-S1 demonstrated a severely degenerative nucleogram and reproduced the patient's usual low back pain.ConclusionsVascular uptake of contrast can occur during lumbar discography, even when the needle tip is ideally located.

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