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