- Back Pain
What is a discography?
A discography, or discogram, is an imaging test of the spine to determine which particular disc is causing a patient’s back pain. The doctor injects a dye into a specific disc to reveal damage on an X-ray image.
A doctor may choose discography for patients with persistent pain when other imaging methods have failed to precisely locate the source of pain. A discogram is most commonly done prior to a lumbar fusion surgery.
A spinal disc is a sponge-like cushion in between the vertebrae of the spine. It has a tough layer surrounding a jelly-like material inside. It has three functions:
- Shock absorption
- To maintain the position of adjacent bones of the spine (vertebrae)
- Spinal flexibility and mobility
A radiologist (a doctor specialized in performing and interpreting imaging tests) performs the procedure. The radiologist injects a dye into a few selected discs, depending on the region of pain, to determine if it produces pain in the patient. They also observe an X-ray and CT monitor to see if there are tears or herniation in the discs that cause the pain.
How is a lumbar discography performed?
The lumbar discography is usually an outpatient procedure. It is likely to take about three hours total, while the procedure itself takes about 30 to 60 minutes, depending on the number of discs planned for testing.
Before the discogram a patient needs to,
- refrain from eating or drinking in the morning before the test
- stop taking blood thinners (such as anticoagulants and aspirin)
The radiologist does not use general anesthesia as the patient needs to be awake and responsive during the procedure. Some may administer a mild sedative to relax the patient. They may also give an antibiotic to prevent infection. They attach an IV line for administering fluids and medications if required.
- The patient lies down on their side or abdomen for the discogram.
- The radiologist injects a local anesthetic to numb the area.
- They insert the needle in the abnormal disc guiding the insertion with the help of a live X-ray image on a monitor.
- The doctor injects the dye in the disc and observes the patient’s pain response.
- The material injected increases the pressure in the disc and may cause pain or pressure.
- The patient must describe the kind of pain, its location and intensity.
- The doctor also studies the imaging results on a live X-ray known as fluoroscopy, and sometimes also on a CT monitor.
- The doctor repeats this process on each of the discs that need to be examined.
The patient remains under observation for 30 to 60 minutes after the procedure.
The patient may feel nothing if the disc is normal or feel some pressure or pain. If the discogram causes a pain that is similar to the pain that the patient has been experiencing, it may indicate that the disc is the source of pain.
If the disc is normal, the injected dye will stay in place, but if it spreads, it may indicate wear and tear or a crack in the disc which may or may not cause pain.
Why is a lumbar discography performed?
A lumbar discography is performed to precisely locate the source of back pain. Typically, the doctor does not rely solely on a discogram, but uses it in combination with CT, MRI and physical examination. The doctor performs a lumbar discography in the following situations:
- To devise alternate treatment plans for persistent back pain conservative treatments like medication, physical therapy and activity modification cannot relieve.
- When less invasive tests have failed to locate the precise location or cause of the pain.
- To decide if a spinal surgery will be effective.
- To assess the disc before a surgery such as lumbar fusion.
How painful is a discogram?
The needle insertions for IV and local anesthetic may cause a mild stinging pain from the pricking.
The discogram is designed to provoke existing pain to find out the source, so certain amount of pain is to be expected. If the disc is normal there will most likely be no pain, there might be a sense of pressure.
If the disc is abnormal, the discogram duplicates the patient’s original pain. The sedation helps reduce the patient’s pain and discomfort, and painkillers can be used to relieve the pain.
How useful is a discogram?
The use of discography as a diagnostic tool has its pros and cons, and doctors only use it when more conservative treatments have failed or surgery is being considered.
The most important advantage is the capacity to pinpoint the problem disc for treatment, which greatly improves the success rate in relieving a patient’s pain. The diagnosis from this procedure also helps in avoiding an unnecessary surgical operation.
Latest Chronic Pain News
Daily Health News
What are the risks and side effects of a discogram?
A discogram performed with due precautions is generally safe. There usually are a few side effects like headache and some amount of back pain that is relieved with analgesics. Following are a few risks and complications:
- Allergic reaction to the dye material
- Exposure to excessive radiation
- Meningitis or discitis caused by infection
- Nerve or blood vessel damage leading to pain or bleeding
- Spinal headache
- Aggravation of the chronic back pain
- Disc herniation
All above are preventable and highly unlikely in a procedure done in a qualified medical facility by a competent radiologist. Disc herniation and paralysis are rare. The procedure’s potential to aggravate chronic back pain still needs further study.
Health Solutions From Our Sponsors
Top What Is a Lumbar Discography Procedure Related Articles
Back Pain: Bad HabitsYou’re more likely to have back pain as you get older. Here’s how to avoid making things worse with bad habits.
16 Back Pain Truths and MythsWhich mattress is best for back pain? Back pain conditions are very common. Learn the causes of upper and lower back pain. Find the truth and get the facts behind back pain myths, remedies, causes and treatment.
Back Pain QuizThere are numerous causes of chronic lower back pain and only one ailment gets more complaints. What is it? Quiz your knowledge of symptoms, treatments, problems, and reasons for common back pain.
Degenerative Disc Disease and SciaticaDegenerative disc disease makes the disc more susceptible to herniation (rupture) which can lead to localized or radiating pain. The pain from degenerative disc or joint disease of the spine is usually treated conservatively with intermittent heat, rest, rehabilitative exercises and medications to relieve pain, muscle spasm and inflammation.
Low Back Pain ExercisesOne of the best low back pain treatments is exercise. Learn more about low back pain exercises--what works, and what doesn't. Discover severe low back pain relief through various gentle workouts designed to protect and strengthen the lumbar, core, and other related muscle groups.
Herniated DiscA herniated disc may be caused by injury or degeneration from age. Symptoms depend on the location of the herniation and whether nerve tissue is being irritated. An MRI or CT scan is performed to diagnose a herniated disc. Treatment may involve physical therapy, cortisone injection, pain medications, anti-inflammatory medications, muscle relaxants, and surgery.
Lower Back PainThere are many causes of back pain. Pain in the low back can relate to the bony lumbar spine, discs between the vertebrae, ligaments around the spine and discs, spinal cord and nerves, muscles of the low back, internal organs of the pelvis and abdomen, and the skin covering the lumbar area.
Low Back Pain ReliefDo you suffer from low back pain? Learn more about common triggers of lower back pain like posture, exercise, and spondylosis. Find out about pain relief treatments like massage, yoga, stretching, exercises for back pain, and chiropractic medicine. See when surgery for back pain makes sense.
Lumbar Puncture (LP or Spinal Tap)A lumbar puncture or "LP" is a procedure whereby spinal fluid is removed from the spinal canal for the purpose of diagnostic testing. It is particularly helpful in the diagnosis of inflammatory diseases of the central nervous system, especially infections, such as meningitis. A lumbar puncture is also known as a spinal tap.
Lumbar Spinal StenosisLumbar stenosis can be caused by degenerative arthritis (the most common cause), tumor, infection, or metabolic disorders (Paget's disease of the bone). Symptoms include low back pain, weakness, pain, numbness, and loss of sensation in the legs. Other conditions may cause similar symptoms of lumbar stenosis, including diabetic neuropathy, claudication, and peripheral vascular disease. Lumbar stenosis may be treated with medication or surgery.
Spinal FusionLower back pain is one of the most common reasons for a visit to the doctor. Lumbar spinal fusion is a surgery where the goal is to have two or more vertebrae fuse together solidly. Minimally invasive spinal fusion is an operation similar to lumbar spinal fusion, however, it a less invasive procedure. There are advantages and disadvantages of the minimally invasive spinal fusion operation.
Nonsteroidal Antiinflammatory Drugs (NSAIDs)
Nonsteroidal antiinflammatory drugs (NSAIDs) are a class of drugs are used to treat inflammation, mild to moderate pain, and fever. Examples of the most common NSAIDs include: aspirin salsalate (Amigesic), diflunisal (Dolobid), ibuprofen (Motrin), ketoprofen (Orudis), nabumetone (Relafen), piroxicam (Feldene), naproxen (Aleve, Naprosyn,) diclofenac (Voltaren), indomethacin (Indocin), sulindac (Clinoril), tolmetin (Tolectin), etodolac (Lodine), ketorolac (Toradol), oxaprozin (Daypro), celecoxib (Celebrex).
Slipped Disc PictureRupturing of the tissue that separates the vertebral bones of the spinal column. See a picture of Slipped Disc and learn more about the health topic.
What is Anterior Cervical Discectomy Used For?Anterior cervical discectomy (ACD) is a procedure to remove a severely damaged or diseased neck bone (cervical vertebrae). There are three main types of anterior cervical discectomy surgeries, one without adding any medical implants, one in which the vertebrae is removed and a bone graft is implanted, and one with a graft and stabilizing metal plate.