From Big Medical Encyclopedia

DISCOGRAPHY (Greek diskos a circle, a disk + grapho to write, represent; synonym nukleografiya) — technique of contrast X-ray inspection of intervertebral disks.

Fig. 1. The diagrammatic representation diskogramm with the contrasted cavities of disks in a side projection: and — is normal (1 — a shadow of a cavity of a kernel roundish; 2 — in the form of a half moon; 3 — in the form of a corner; 4 — in the form of parallel shadows; 5 — in the form of «cuff link»); — with dystrophic changes (1 — initial; 2 — expressed; 3 — with back protrusion; 4 — with a back rupture of a disk; 5 — with front protrusion).
Fig. 2. The roentgenogram (diskogramma) of lumbosacral department of a backbone in a side projection: dystrophy of a disk with back protrusion (it is specified by an arrow) between L4 and L5.
Fig. 3. The roentgenogram (diskogramma) lower cervical and upper a chest backbone of departments in a direct projection: dystrophy of disks between C6 and C7, C7 and Th1, the capacity of the contrasted part of disks is increased, a contrast agent streamed in an epidural space (it is specified by shooters).

It was for the first time applied by the Soviet doctors B. P. Popov and H. Odessa (1944) at a gunshot wound of an intervertebral disk. Then the Swedish radiologist Lindblum (To. Lindblom, 1948) suggested to use D. for diagnosis of dystrophic processes in disks of lumbar department of a backbone. Make also at injuries and hernias of disks (see. Shmorlya small knots ), at nevrol, disturbances and frustration of a statics.

The limited from above and from below to the cartilaginous closing plates, intervertebral disks consist of a fibrous ring and a jellylike kernel with the small cavity filled with synovial fluid. At D. enter a contrast agent into this cavity.

At a discography various accesses can be applied. For a research of disks of lumbar department of a backbone use transmeningeal access (Lindblum, 1948): the patient lies on one side with the bent legs; the aspirating needle is carried out through a dural bag and further to a disk. At peridural access [P. Erlacher, 1952] the needle is entered on 1,5 cm lateralny the corresponding acantha and directed up and knutr along the medial surface of an intervertebral joint, leading her through peridural space to a disk between a dural bag and nervous roots.

G. S. Yumashev and L. L. Silin (1967) suggested to carry out a needle to a disk by means of a lattice-napravitelya under control of raying or X-ray analysis. This technique allows to enter a needle practically into any department of a backbone.

As contrast agents at D. solutions of triyodirovanny water-soluble drugs apply 30 — 70% (e.g., 50% and 70% solution of Urografinum). Enter 0,2 — 0,7 ml of a contrast agent under a local infiltration anesthesia of 2% into a normal disk solution of novocaine (5 ml); previously enter (intravenously) 2% solution of Promedolum (1 ml), 2,5% solution of Pipolphenum (2 ml) and 50% solution of analginum (2 ml).

Roentgenograms make in direct and side (fig. 1 — 3), and sometimes in slanting projections. Diskogramma is estimated on filling with a contrast agent of a cavity of a pulpozny kernel of a disk (nukleografiya). Normal the cavity of a disk has various form — roundish, a form of an ellipse, a half moon, a cuff link (fig. 1, a).

Ratios of the contrasted part of a disk and diameter of a disk both on a straight line, and on side roentgenograms make 1:3 — 1:4. At dystrophic changes of a disk the capacity of his cavity increases, outpouring of a contrast agent out of limits of a cavity of a kernel can be observed.

In the presence of a protruded disk an exit of contrast weight out of limits of its anatomic contour in the form of protrusion is characteristic. At a rupture of a disk owing to an injury change of a contour of the contrasted cavity with possible penetration of a contrast agent into fabrics out of limits of a disk (fig. 1,6) is observed.

Carry out with observance of rules of an asepsis; after D. appoint dehydrational, antimicrobic, analgetic therapy. At violation of the rules of an asepsis there can be such complications as a discitis, meningitis, an arachnoiditis. Reaction to iodinated drugs in the form of an acute anaphylaxis and giperergichesky reaction is possible.

To it is contraindicated at acute inflammatory and dystrophic diseases of a liver and kidneys with disturbance of their function, severe damage of a myocardium, the expressed cardiovascular insufficiency, active tuberculosis, a hyperthyroidism, an idiosyncrasy to iodine, sharply expressed deforming spondylosis with consolidation of vertebrae.

See also Backbone (radiodiagnosis) .

Bibliography: Expert Ya. K. Lumbosacral radiculitis (clinic and surgical treatment), M., 1971, bibliogr.; Mikheyev V. V., etc. Damages of a spinal cord at diseases of a backbone, M., 1972; B. P. Priests iodes-with to and y I. N. Radiodiagnosis of fire defeats of an intervertebral disk and their clinical current, Surgery, No. 9, page 71, 1944; Yumashev G. S. isilin JI. L. Injuries of bodies of vertebrae, intervertebral disks and sheaves, Tashkent, 1971, bibliogr.; Z and with about b s G. Century, P i 1 1 about n e P. B. a. M a z z o-1 R. Lumbar discography in the diagnosis of herniated disks, Int. Surg., v. 60, p. 6, 1975; Roth D. Cervical analgesic discography, J. Amer. med. Ass., v. 235, p. 1713, 1976; Walk L. Lumbar discography and its clinical evaluation, Springfield, 1962.

G. S. Yumashev.