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Annulogram vs. Discogram For Back Pain Evaluation


If you suffer from chronic back pain, your doctor may have recommended that you undergo a discogram evaluation. However, if you have not been made aware of the risks associated with discograms and what your other options are, you may not be able to make a well-informed decision before undergoing this evaluation. Discograms have been known to do more harm than good to spinal discs, so it’s worth learning the facts and differences between an annulogram and discogram before taking this recommendation at face value.


A discogram is an imaging test that is commonly used to evaluate a patient’s back pain before determining whether or not spinal fusion is an appropriate treatment option. If you have back pain, the discogram will help your doctor evaluate your spinal discs and determine if any are abnormal. After this, your doctor can figure out if an abnormal disc is the cause of your back pain.3

Discograms are generally recommended only if a patient fails to feel relief from back pain after undergoing conservative treatment, such as physical therapy or medication. This test is invasive and usually isn’t used as an initial test to find the cause of back pain.3


The process of the discogram will involve the injection of dye into the center of one or multiple spinal discs. If the outer portion, or annulus fibrosus, of the spinal disc has tears, the dye will move into these tears and reveal them. This makes annulus fibrosus tears, also referred to as annular tears, visible on an X-ray or CT scan.3


Unfortunately, discs with annular tears don’t always cause symptoms. Because of this, discograms cannot always precisely determine which discs are the cause of a patient’s back pain, or if spinal discs are even the cause of pain. This makes discograms controversial in evaluating spinal discs, especially for the purpose of determining which spinal discs should be removed for spinal fusion.3

Further, various studies have been conducted and show that discograms may even damage discs.

A 2009 ISSLS prize-winning study found that spinal discs that were exposed to the puncture and injection involved in discogram testing had an increased progression of degeneration than control discs, which were not punctured or injected. In fact, an excessive amount of new disc herniations were found in discs that had been punctured. Discs that underwent discogram testing also exhibited a greater loss of height and signal intensity.1

Overall, discogram techniques involving small gauge needles and pressurization culminated in increased disc degeneration, disc herniation, and loss of disc height and signal, along with other issues.1

A 10-year study published in 2015 with the goal of determining the effects of lumbar discogram testing on patients found that medical visits, CT scan, and MRI examinations, loss of work, and prolonged episodes of back pain were more common in the group that had undergone discography than the control group. Further, the group that underwent discograms had 16 lumbar surgeries, compared to only 4 in the control group.2

The study also determined that the puncture and pressurization used in discograms increased patients’ risk of clinical disc issues.2


Annulograms, in contrast to discograms, are much gentler on spinal discs, and the test is painless. The goal of the annulogram is also to determine whether spinal discs have annular tears, however, unlike discograms, annulograms are focused on determining whether these tears have caused the spinal discs to leak.

The reason for this is that most back or neck pain is caused by the nucleus pulposus leaking out from the inner part of the spinal disc, causing irritation and inflammation in the disc’s annulus as well as in surrounding nerves.

The Annulogram Process

The annulogram is a necessary part of the Discseel® Procedure during which a water-soluble contrast will be injected into the disc or discs. At the same time, a live X-ray is utilized to see the flow of the contrast and identify any annular tears within each disc.

After this, Fibrin, an FDA-approved substance that is used off-label, is injected into each disc containing annular tears that have caused discs to leak, in order to seal and heal the discs.

Although annulograms are similar to discograms in their goal and process, this is not a standalone test, but an important part of the Discseel Procedure.

While discograms may be more common and well-known than annulograms, it’s been shown that these tests are both detrimental to the spine and not particularly effective. If you suffer from back pain that has failed to be relieved by conservative treatment, the Discseel Procedure may be the right option for you.

Apply today and find out if you’re a candidate for this life-changing procedure.

  1. Carragee, Eugene J., et al. “2009 ISSLS Prize Winner: Does Discography Cause Accelerated Progression of Degeneration Changes in the Lumbar Disc: A Ten-Year Matched Cohort Study.” National Center for Biotechnology Information, U.S. National Library of Medicine, 1 Oct. 2009,
  2. Cuellar, Jason M., et al. “Does Provocative Discography Cause Clinically Important Injury to the Lumbar Intervertebral Disc? A 10-Year Matched Cohort Study.” The Spine Journal : Official Journal of the North American Spine Society, U.S. National Library of Medicine, 29 June 2015,
  3. Discogram. 26 Feb. 2020,