Annulograms and discograms are diagnostic procedures used to evaluate spinal disc health. While both diagnostic procedures are utilized to assess the condition of the intervertebral discs, they differ significantly in their methodology and applications.
What are Annular tears and why are they so important?
Annular tears are the true, underlying cause of all disc problems, including disc herniation, bulge, degeneration, protrusion, pinched nerve, prolapsed disc, all of which result from annular tears. Ironically, Annular tears are rarely discussed because, prior to the Discseel® Procedure, no treatment existed to repair Annular tears.
Annular tears are cracks in the annulus fibrosus. The annulus fibrosus is comprised of seventeen layers which encircle the disc’s center nucleus pulposus gel. There are pain nerves within these layers. When annular tears allow gel to leak outwards, the gel is “perceived” as a “foreign substance” by the human body and causes inflammation of the annular layers, which is the true cause of low back pain. If there are many annular tears, they allow gel to leak outwards onto spinal nerves adjacent to discs, causing inflammation involving the nerve tissue. Spinal nerve inflammation is called “radiculitis” (aka sciatica or radiculopathy.) and so radiculitis is caused by spinal nerve inflammation and not by “pinched nerves” as was once thought. This explains why epidural steroids occasionally provide temporary relief. However, if discs continue leaking through annular tears, they need the Discseel® Procedure to repair annular tears.
Annulograms are advanced diagnostic tools that help visualize the internal structure of the disc annulus, which is the outer fibrous ring of an intervertebral disc. This procedure is particularly useful in detecting early annulus fissures—small tears or cracks in the disc annulus that can lead to disc related pain. Annulograms are designed to reveal structural abnormalities without purposefully provoking discomfort to the patient.
Discograms, on the other hand, are intentionally pain-provoking diagnostic tests. In a discogram, contrast dye is injected into the center of the disc (nucleus pulposus) under pressure, which can exacerbate any existing pain by reproducing the patient’s typical pain symptoms. This procedure aims to identify which discs are the source of the pain by correlating the patient’s pain response with the imaging findings.
Pain-Free Annulograms vs. Pain-Provoking Discograms
The primary difference between annulograms and discograms lies in the pain response. Annulograms, being non-provocative, allow for the identification of structural disc issues without inducing pain. This is particularly advantageous for patients who are already suffering from chronic pain, as it minimizes additional discomfort during the diagnostic process. Annulograms utilize imaging techniques such as fluoroscopy to visualize the disc integrity, focusing on the annulus fibrosus. These images can reveal early-stage annular fissures, which are small cracks or tears that may not yet be causing significant symptoms and not yet revealing themselves on MRI. These small fissures have the potential to develop into painful conditions if left untreated.
Discograms, conversely, are designed to provoke pain to determine if a given disc is causing the patient’s discomfort. The procedure involves injecting contrast dye into the disc and applying pressure to see if it replicates the patient’s pain. This can provide valuable information about which discs are problematic and the nature of the pain, but it comes at the cost of increased patient discomfort. The provocative nature of discograms can sometimes lead to false positives or negatives due to the subjective nature of pain and the stress response induced by the procedure.
Annulograms and Early Detection of Disc Annulus Fissures
One of the significant advantages of annulograms is their ability to detect early annulus fissures before they become apparent on traditional MRI scans. MRIs are typically used to diagnose more advanced stages of disc degeneration, where structural changes and abnormalities are more pronounced. However, early-stage fissures can be very small and might not show up on standard MRI images.
Annulograms can identify these small fissures early on. Detecting these early fissures is crucial because they represent the initial stages of discogenic pain—a type of pain originating from a damaged intervertebral disc. Early detection allows for timely intervention, potentially preventing the progression of the fissures into more severe disc degeneration and chronic pain.
Discseel®: Utilizing Annulograms for Nonsurgical Spine Procedures
Discseel® is a pioneering nonsurgical spine procedure that leverages the diagnostic capabilities of annulograms. Discseel® involves injecting an FDA-approved biologic into the damaged disc to promote healing and regeneration. This procedure is unique in its use of annulograms to precisely identify and target early annulus fissures. By pinpointing these fissures, Discseel® can deliver the biologic directly to the affected area, facilitating more effective treatment and repair of the disc.
The use of annulograms in the Discseel® procedure highlights the importance of early and accurate diagnosis in managing discogenic pain. By addressing the root cause of the pain at an early stage, Discseel® offers a promising alternative to traditional surgical interventions, which can be more invasive and carry higher risks.
Conclusion
Annulograms and discograms are diagnostic tools for assessing intervertebral disc health, but they differ significantly in their approach and applications. Pain-free annulograms provide a method for detecting early annulus fissures, offering a significant advantage in the early diagnosis and treatment of discogenic pain. In contrast, pain-provoking discograms, while effective in pinpointing the source of pain, can cause discomfort and may not be suitable for all patients. The innovative Discseel® procedure exemplifies the potential of annulograms in nonsurgical spine treatments, underscoring the importance of early detection and targeted intervention in managing spinal disc conditions.
