The use of spinal discography has been controversial since its inception. Although its intended common uses and indications have changed over the decades, questions about its reliability and how to interpret results have persisted. As it has evolved from a primary diagnostic tool for spinal disc protrusions in the pre-computed tomography (CT) and pre-magnetic resonance imaging (MRI) eras to a more limited role in evaluating the nature of suspected painful discs, the controversies have continued. Here, the author reviews the historical evolution of spinal discography and recent literature focused on the role of provocative discography in evaluating patients with neck pain and/or lower back pain. Currently available literature pertinent to this issue is summarized for lumbar, cervical, and thoracic discography. Many worthwhile studies are omitted from this literature review only to focus on those that relate directly to evaluating discography's role in screening potential patients for surgical intervention. The use of discography to identify patients for interventional pain procedures is not evaluated. How recent technology in spine surgery has affected current usage of discography is then reviewed. The author concludes by summarizing his current practice and opinions regarding discography.