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Biologic Discography: Exploring Alternatives To Discography

Medically Reviewed By:

Dr. Chaz Fausel, MD

Dr. Chaz Fausel is a Denver-based interventional orthopedics specialist and Regenexx educator, trained at Emory and the Centeno-Schultz Clinic.

Discography has historically been approached with some skepticism. It involves puncturing a disc to help determine structural damage, often by attempting to reproduce a patient’s symptoms. This diagnostic-only use raised concerns, especially when the procedure did not lead to a targeted therapeutic intervention.

However, as interest in regenerative treatments grew, the view of discography began to change. It is now seen not just as a diagnostic tool, but as a means to help identify discs that might respond to orthobiologic interventions.

Preclinical studies using platelet-rich plasma (PRP) have shown potential to help support disc tissue repair in animal models. Improvements in disc height and matrix composition were observed on MRI and histological analysis.[1] These findings helped lay the groundwork for discography’s evolving use. The procedure may now be used not only to assess disc structure but also to help guide orthobiologic treatment decisions, including those involving Regenexx processing techniques.

As a result, discography has transitioned from a purely diagnostic tool to a process that may help identify discs that are potential candidates for orthobiologic treatment intended to help support tissue repair. Although this approach has been used in clinical practice for years, formally naming and discussing it may help expand its role in interventional orthobiologics and encourage ongoing innovation among physicians in this field.

Disc Pain And Discography Defined

The intervertebral discs that sit between the spinal bones act as cushions and shock absorbers. Each disc has a tough outer layer (annulus fibrosus) and a gel-like center (nucleus pulposus). Over time, the outer layer may develop damage or tears, which may contribute to discomfort or pain.

Discography is a diagnostic procedure that may assist in identifying whether a disc is potentially involved in generating symptoms. It is performed under fluoroscopic (X-ray) guidance, where contrast dye is injected into one or more discs to evaluate disc structure and pain response. As each disc is pressurized, the patient reports whether the sensation matches their typical symptoms.

This approach may help determine whether a specific disc could be contributing to discomfort and whether structural changes such as annular tears are present.

While MRI can detect disc tears or other degenerative changes, these findings do not always correlate with symptoms. Many age-related changes appear on imaging even in individuals who do not experience pain. In certain cases, discography may offer additional insight by helping correlate structural findings with reported symptoms.

Watch the video below to learn more:

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The Problem With Discography

While a discography may provide useful diagnostic information, it also carries potential risks. Introducing a needle into the disc to deliver contrast material and apply pressure may lead to:

  • Infection
  • Structural injury to the disc
  • Acceleration of existing degenerative disc changes

These effects may be more likely when combined with corticosteroids or certain anesthetics. For example, research suggests that elevated cortisol — produced in response to chronic pain—may impair the function and regenerative potential of disc cells.[2]

Additionally, commonly used local anesthetics such as lidocaine and bupivacaine have been shown to negatively affect disc cell health, contributing to increased cell death and structural tissue changes.[3] While these agents are widely used in spinal procedures, these findings raise important considerations for long-term disc integrity, particularly in already degenerated tissues.

Although epidural steroid injections are nonsurgical, studies have also shown that steroids may negatively affect cartilage. This further underscores the importance of considering how different injectates may impact cell viability and disc structure over time.

By contrast, orthobiologic approaches—which do not use corticosteroids or standard anesthetics—may offer a different strategy. These biologic injectates, including platelet-rich plasma (PRP), have been studied in both clinical and animal research for their potential to support disc tissue repair and promote a more favorable cellular environment.

Biologic Discography May Help Avoid Discography Side Effects

Biologic discography is an emerging approach that involves delivering orthobiologic treatments, such as PRP, into the disc space after contrast dye injection. Unlike corticosteroids or certain anesthetics—which have been associated with negative effects on disc cells in lab studies—PRP is derived from the patient’s own blood and has been studied for its potential to support disc tissue health.

Because discography involves pressurizing and puncturing the disc, this method also presents an opportunity to introduce a biologic agent that may help modulate the tissue response to the procedure. Clinical research has supported the use of PRP for disc-related symptoms, and ongoing studies continue to explore the potential of other orthobiologic compounds in this context.

The rationale is straightforward: if the disc must be punctured for diagnostic purposes, biologic discography may offer a way to also deliver substances that have been studied for their ability to help support a healthier disc environment.

The Technical Differences Between Traditional And Biologic Discography

There are notable technical differences between typical and biologic discography.

First, in the biologic approach, a smaller volume of contrast dye is typically used because an orthobiologic solution—such as PRP—is also introduced into the disc during the same procedure.

Watch the video below of Dr. Pitts performing a procedure using Regenexx lab processes:

Second, corticosteroids and typical anesthetics—both of which have been associated with potential negative effects on disc tissue in some studies—are avoided.

Third, the orthobiologic is injected directly into visible annular tears and along the tear pathway during needle withdrawal. This may help coat the puncture tract and maximize contact with affected tissue.

Injecting Anything Into The Disc Is High Risk

Disc injections are among the most invasive spinal procedures involving a needle and may be considered more complex than other common spine interventions, such as epidural or facet injections. For this reason, they should be reserved for carefully selected cases.

In some individuals, biologic discography may be a useful option—particularly when a symptomatic disc tear has been identified as a likely source of pain. This technique may also be considered when disc-related inflammation is contributing to nerve irritation.

However, not everyone with back pain is a good candidate for injections into the disc. Many spinal issues—such as disc herniation, ligament laxity, or facet joint problems—may often be treated effectively with less invasive orthobiologic procedures that do not require entering the disc space.

In cases of advanced disc degeneration or severe disc collapse, the disc environment may not be responsive to biologic injections. These situations may require alternative strategies focused on adjacent structures or overall spine stability.

For a thorough review of spinal conditions and non-surgical treatment options using advanced biologics, watch the video below:

Not all providers offering orthobiologic injections adhere to the same stringent standards. Some may offer injections for various disc-related issues without a thorough evaluation. Proper patient selection is critical, and a careful diagnostic process should precede any procedure involving the disc space.

Provider expertise also matters. Disc injections are technically demanding, and limited training may not be sufficient for safe and helpful treatment. Materials like fibrin sealants are sometimes promoted to help repair disc damage, but research suggests these substances may break down quickly and may provide only short-term effects.

Looking ahead, biologic discography may support more targeted and tissue-friendly diagnostics. Until then, clinical judgment should guide decisions about disc puncture, with orthobiologics like PRP considered when appropriate to help support disc tissue following pressurization.

Spine Conditions Managed With The Regenexx Approach

The Regenexx approach provides non-surgical treatment options for a range of spine-related conditions using non-surgical orthobiologic procedures. These are performed by physicians within the licensed Regenexx network and may help reduce pain and may help improve function in appropriate candidates.

Below are examples of spine conditions that may be treated using procedures involving Regenexx processing techniques:

  • Annular Tears: An annular tear is a small rupture in the outer layer of a spinal disc, which may cause localized back pain or nerve irritation. Symptoms can vary, with some tears leading to radiating pain, numbness, or weakness if the disc presses on nearby nerves.
  • Foraminal Stenosis: Foraminal stenosis occurs when the openings where spinal nerves exit the vertebrae narrow, potentially compressing the nerves. Depending on the affected spinal level, this may cause pain, numbness, tingling, or weakness in the back, arms, or legs.
  • Pinched Low Back Nerve: A pinched low back nerve occurs when surrounding structures compress a nerve in the lumbar spine, leading to pain, numbness, tingling, or weakness in the lower back, hips, or legs. Symptoms may vary based on the severity and location of the nerve compression.
  • Herniated Disc: A herniated disc may interfere with daily routines, making simple tasks such as sitting, standing, or lifting more challenging. Discomfort may also spread into the arms or legs, impacting sleep and reducing physical activity over time. Read More About Herniated Disc.
  • Bulging Discs: A bulging disc occurs when a spinal disc extends beyond its normal space without rupturing. Depending on the affected area, it may cause localized pain or nerve compression, leading to numbness, tingling, or weakness in the back, neck, or limbs. Read More About Bulging Discs.
  • Spinal Stenosis: Spinal stenosis is when the spinal canal narrows, putting pressure on the spinal cord or nerves. It may cause pain, numbness, tingling, or weakness in the back, legs, or arms, often worsening with prolonged standing or walking. Read More About Spinal Stenosis.
  • Spondylolysis: Spondylolysis is a stress fracture or defect in the vertebra, most commonly in the lower back. It may cause localized pain, stiffness, and, in some cases, nerve irritation, often worsening with activity or prolonged standing.

Considering Biologic Discography? Start with an Informed Evaluation

Biologic discography represents an evolving approach to disc diagnosis and treatment, aimed not only at identifying pain-generating discs but also at helping support the disc environment through advanced orthobiologics like PRP.

The focus of the Regenexx approach is on precision, patient safety, and research-informed care. For those exploring non-surgical options for disc-related back pain, the first step is a thorough evaluation to determine whether they are a candidate for biologic discography or another orthobiologic procedure.

Schedule a consultation with a physician in the licensed Regenexx network to learn more about a patient’s condition and the most appropriate treatment options.

References:

  1. Akeda K, Yamada J, Linn ET, Sudo A, Masuda K. Platelet-rich plasma in the management of chronic low back pain: a critical review. J Pain Res. 2019 Feb 25;12:753-767. doi: 10.2147/JPR.S153085. PMID: 30881089; PMCID: PMC6394242. https://pmc.ncbi.nlm.nih.gov/articles/PMC6394242/
  2. Muzin S, Isaac Z, Walker J 3rd. The role of intradiscal steroids in the treatment of discogenic low back pain. Curr Rev Musculoskelet Med. 2008 Jun;1(2):103-7. doi: 10.1007/s12178-007-9015-y. PMID: 19468881; PMCID: PMC2684212. https://pmc.ncbi.nlm.nih.gov/articles/PMC2684212/
  3. Iwasaki K, Sudo H, Yamada K, Higashi H, Ohnishi T, Tsujimoto T, Iwasaki N. Effects of single injection of local anesthetic agents on intervertebral disc degeneration: ex vivo and long-term in vivo experimental study. PLoS One. 2014 Oct 6;9(10):e109851. doi: 10.1371/journal.pone.0109851. PMID: 25286407; PMCID: PMC4186881. https://pmc.ncbi.nlm.nih.gov/articles/PMC4186881/

Medically Reviewed By:

Dr. Chaz Fausel, MD

Dr. Chaz Fausel is a Denver-based interventional orthopedics specialist and Regenexx educator, trained at Emory and the Centeno-Schultz Clinic.
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