Discography

NORMAL Discography ABNORMAL Discography

What is Discography?
Discography is a diagnostic procedure, not a treatment. X-ray dye is injected into the spinal disc(s) and an x-ray (called a "discogram") is taken. The discogram may be normal or may show tears (fissures) in the lining of the disc. The results of discography can be used to plan spinal surgery or IDET (IntraDiscal ElectroThermal Therapy) or Nucleoplasty.

How do I know if my pain is from a damaged disc?
With age or from an injury, the wall of the spinal discs can become damaged (such as a fissure.) This condition is call Internal Disc Disruption or Degenerative Disc Disease. The wall of the disc can weaken and protrude out (a herniated disc). When the disc causes pain, the pain is usually felt as a deep ache in the back and sometimes in the buttocks and into the thigh. Pain from facet joints in the back and from the sacroiliac (SI joints) can be in the same location and feel the same. The best way to tell if the pain is from a damaged disc is with discography.

How is Discography performed?
The procedure is done in a surgical center with fluoroscopic (x-ray) guidance. For lumbar discography it is done with you lying on your stomach. You will be given intravenous sedation to help you be comfortable and relaxed. You are watched closely with an EKG monitor, blood pressure cuff and blood oxygen-monitoring device. The skin over the injection site(s) is cleaned with an antiseptic solution and then the injections are performed.

What will I feel during the injection?
When a normal disc is injected, you will feel a sense of pressure, not pain. When an abnormal disc is injected, you will feel pain. It is important to try to determine if the pain you are feeling is your “typical pain” or not. When each disc is injected, you will be asked if it is painful, where you feel the pain and whether it is in the same area as your usual pain.

How many discs will be injected?
Based on your symptoms and your MRI, your doctor will determine which disc(s) may be causing your pain. These disc(s) will be injected and evaluated. In addition, a normal disc is injected to serve as a reference point.

How long does Discography take?
Discography takes about 30 to 45 minutes, depending on how many levels are injected.

What is actually injected?
The injection consists of x-ray dye. Saline is also injected to reproduce the patient’s symptoms.

Will the injections hurt?
The procedure involves inserting a needle through skin and deeper tissues, so there is some discomfort involved. However, your doctor will numb the skin and deeper tissues with a local anesthetic using a very thin needle prior to inserting the needle into the disc. Most of the patients receive intravenous sedation and pain medication, which makes the procedure easy to tolerate.
You may have a flare-up of your back pain after the injection, but this gets better in a day or two and can usually be managed with ice packs and oral pain medication.

Will I be "put out" for this procedure?
No. This procedure is done under local anesthesia (“novocaine.”) Most of the patients also receive intravenous sedation and analgesia, to help them relax and make the procedure easier to tolerate. The amount of sedation given depends upon the patient. During the discogram injections, you need to be awake enough to tell the doctor what you are feeling.

Will my pain be better after the injection?
No. Discography does not treat your condition. It is a diagnostic test that allows your doctors to plan your therapy.

What should I do after the procedure?
We advise patients to take it easy the day after the procedure. You may need to apply ice to the affected area for 20-30 minutes at a time for the next day. You can then perform activities as tolerated. Your doctor will provide specific activity restrictions if indicated.

What are the risks and side effects of discography?
Generally speaking, this procedure is safe. However, with any procedure there are risks, side effects, and possibility of complications. The most common side effect is discomfort, which is temporary. Sometimes, the discogram needle brushes past a nerve root and the nerve root is irritated. This pain gets better quickly. The other risks involve infection, bleeding, and worsening of symptoms. Fortunately, because the procedure is performed with X-ray in a controlled environment, serious side effects and complications are rare.

Who should not have this injection?
If you are allergic to any of the medications to be injected, if you are on a blood thinning medication (e.g. Coumadin®, Plavix®), or if you have an active infection, you should not have the procedure.