A Discogram refers to a procedure commonly used in the lumbar spine but also in the cervical spine (neck). If your physician is suspecting a disc to be the pain generating area in your back, a Discogram may identify this more clearly. On rare occasions, Discograms along with a CT scan (CT-Discogram) may identify a herniated disc better than other studies currently available. This study is commonly used prior to a fusion procedure after unsuccessful use of non-operative treatments.
Discography is performed by placing a needle (after numbing the surrounding skin) into the disc space and injecting a liquid (dye) that can be seen under X-ray. In normal individuals, this injection produces only mild discomfort. In patients with disc disease, the injection process and the resulting elevation of pressure within the disc space, will reproduce the pain that is felt by the patient on day to day basis.
Patients commonly complain of moderate discomfort in the area for a few days. Anti-inflammatory medications (Advil, Naprosyn, etc.) could be used to reduce the pain. On occasions, narcotic medications may be used as well. After the Discogram the physician may recommend a CT scan to see the internal architecture of the disc. This may help with the diagnosis and direct the decision making process.
Although many physicians extensively use Discograms, others feel that information obtained does not change the course of treatment. At this time its use is physician dependent.
Possible risks are uncommon but include disc space infection and nerve root injury. To avoid infection, strict sterile technique is used during this procedure. Some physicians may choose to mix the injected dye with an antibiotic solution
- The procedure is performed on an outpatient basis and may take up to 2 hours.
- A driver should accompany the patient home.
- Do not eat or drink anything 6 hours prior to the procedure.
- Avoid all blood thinners, anticoagulants, and aspirin type medications 7 days prior to the procedure.
- Continue taking all other medications.
- Avoid taking other pain medications as they may interfere with interpretation of the results.
- If you are allergic to iodine dye, be sure to inform your physician prior to the procedure.
The result of this test is provided to the patient on the following visit. A treatment plan is provided based on this information. Your spine surgeon is best able to evaluate these results and provide further recommendations.What is lumbar diskography and why is it helpful?
Discography is used for surgical planning prior to a lumbar fusion. Discography may confirm or deny that the disc(s) are the source of pain. Your surgeon needs to be absolutely sure that the level or levels being fused are responsible for your pain. The procedure involves placement of a needle into the disc utilizing x-ray guidance and injecting contrast (x-ray dye). The procedure is usually done if the patient’s pain is significant enough for the surgeon to consider surgery.
What are discs?
The discs are soft, cushion-like pads, which separate the hard vertebral bones of the spine. A disc may be painful when it bulges, herniated, tears or degenerates and may cause pain.
How is the procedure performed?
Diskography is performed in an operating room setting as an outpatient procedure. An IV will be started so that antibiotics (to prevent infection) and relaxation medication can be given. You will be lying on your stomach on a special x-ray table. All precautions will be taken to ensure a sterile environment during the procedure. The areas for diskography will be prepped in a sterile fashion and sterile drapes will be applied. A local anesthetic will be used to numb the skin over these areas. Your physician will direct a small needle(s), using x-ray guidance into the disc(s). When proper placement has been confirmed by fluoroscopy (x-ray), the discs are “pressurized” one at a time. Pressurization consists of injecting small amounts of contrast (x-ray dye) into the center of the disc(s). This is an important part of the study for two reasons. First injecting contrast into the disc(s) may show pathology that is not otherwise revealed on conventional imaging studies and secondly the pressurization of the disc(s) will serve as a provocative test to determine if the disc(s) in question are the source of your pain. You will be asked what sensation you are feeling. You essentially have three choices: 1. You feel nothing 2. You feel pressure 3. You feel pain. If you feel pain during pressurization you must respond if the pain is familiar (“That’s my pain”) or unfamiliar (“I’ve never felt that pain before”). Your response will aid in determination of which level(s) are involved in your pain process. The entire procedure should take less than one hour.
Is the procedure painful?
You may feel some uncomfortable sensations at times during the pressurization of the disc(s). You will receive sedation during the procedure and discomfort will be kept to a minimum. Post procedure, you may experience some injection site tenderness for several days. Ice packs the first day usually will control any discomfort.
Are there any risks or side effects from the procedure?
Any time there is an injection through the skin, there is a risk of infection. This is why sterile conditions are used for this procedure. Although rare, risks associated with lumbar diskography include discitis, epidural abscess formation, possible nerve injury from direct needle trauma, bleeding, possible worsening of pain, and a headache that may last for up to one week.
Who should not have this procedure?
If you are on blood thinning medication (e.g. Coumadin, Plavix), or if you have an active infection or fever, you should not have the procedure. The procedure can be performed after a period of time when either blood thinning medication has been stopped, or when no active infection or fever is present. If you are pregnant, you should not have this procedure.
What are my pre/post procedure instructions?
Patients should have nothing by mouth for 6 hours prior to the procedure. If you take pain medication or anti-inflammatory medication, you should stop taking them the day of the procedure. Your medicines can be restarted afterwards if they are needed. After the procedure you may have some soreness from the needle punctures that lasts several days. You may apply an ice pack for 15 minutes at a time to ease the soreness. You will need a ride home and you should not drive yourself for at least 8 hours following the procedure. If you develop fever the following day(s), notify the office immediately. Occasionally you might develop a headache. If this occurs, you can take medication such as Tylenol or Motrin. Increasing your fluid intake and consumption of caffeine drinks such as coffee or colas will usually help relieve the headache.