To investigate the causes of false-negative discograms, 181 lower
thoracic and lumbar intervertebral discs that had been removed as part of
en bloc specimens during thirty autopsies were studied first by discography
and then histologically. Comparison of the results of the two methods
showed that if fissures and cysts were present in a degenerated anulus
fibrosus, but did not establish continuity between the nuclear cavity and
the site of a herniation, the discogram was false-negative. Under these
circumstances, the inner fiber bundles of the anulus fibrosus were intact
and their orientation was often reversed, so that they bulged inward. This
finding suggested that a protrusion or a prolapse of tissue from just the
anulus fibrosus might have been developing. Ten of the fifty-seven discs
that had such changes in the orientation of the fibers had a histologically
proved protrusion or prolapse of the anulus fibrosus. However, the
discograms showed protrusion in only six of the ten discs and demonstrated
a false-negative result in the other four. The cases of seventy-seven
patients in whom discography had been performed and a herniation had been
subsequently confirmed at operation were also studied. Fifty-nine of the
patients had a protrusion and eighteen had a prolapse of the disc. The
discograms were falsely interpreted as negative in 32 per cent (nineteen)
of the fifty-nine patients who had a protrusion and in 56 per cent (ten) of
the eighteen who had a prolapse. Histologically, the prolapses were
interpreted as protrusions of a portion of the anulus fibrosus. It was
concluded that false-negative discograms are more frequent when a
protrusion or a prolapse involves the anulus fibrosus rather than the
nucleus pulposus, and that a negative discogram does not exclude the
possibility of extensive degeneration of the anulus fibrosus.