Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Dr. Helm has been practicing interventional pain management since 1982. Dr. Helm is a diplomate of the American Board of Anesthesiology with subspecialty certification in Pain Medicine and of the American Board of Pain Medicine. Dr. Helm is a Fellow of Interventional Pain Practice (FIPP), the only certifying agency which tests the ability to perform interventional pain procedures. Dr. Helm is also an examiner for FIPP.
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
What is the anatomy of the disc of the spine (intervertebral disc)?
The disc is an important structure that rests between the bony building blocks of the spine (vertebrae). The disc in the spine is sometimes referred to as the intervertebral disc. Intervertebral discs help provide flexibility to our spine. They also lessen the effect of impact on our spine by cushioning the bony vertebrae. The disc is designed somewhat like a jelly donut. The disc has a stronger outer layer (the annulus) that is rather like a radial tire, and an inner gel (the nucleus) that acts as a sort of shock absorber or cushion between the bones of the spine.
Picture of Vertebral Body, Nerve, and Disc
What happens to the disc with injury or age?
With injury or age, these discs can become damaged, and the supporting ligaments surrounding them weaken. One of the reasons we lose height as we age is that the intervertebral discs lose their water content. This leads to shrinkage of the disc and, as a result, height diminishes.
What is a discogram used for?
An injured disc can be a source of pain. A discogram is used to determine if a particular disc is the source of pain. Discograms are provocative tests, meaning that they attempt to reproduce rather than remove pain. The reproduction of pain during a discogram can help determine if injury to a particular disc is the source of a person's pain.
How is a discogram performed?
When performing a discogram, a needle is inserted into the disc and a contrast dye is injected. This extra fluid in the disc increases the pressure in the disc. Patients with an injured disc may then experience pain that can mimic the pain they have been experiencing. The intensity of the pain is recorded on a 0-10 scale. Based upon this information, the diagnosis of a particular disc injury can be made. The doctor can then determine what the optimal treatment options are for relief of the underlying pain.
Picture of Discogram Using Fluoroscope
[An actual discogram as visualized using an x-ray viewing instrument called a fluoroscope]
What happens after the procedure?
Patients may be sore for several days after the procedure. Any discomfort can be treated with the local application of ice packs or with a cooling pad on and off for periods of twenty minutes.
Medically reviewed by Aimee V. HachigianGould, MD; American Board of Orthopaedic Surgery
"Diagnostic testing for low back pain"