Discography is a diagnostic test to evaluate an abnormal spinal disc, both structurally and functionally. Damaged spinal discs may cause severe back and leg pain or neck and arm pain by irritating nerves. The discogram may reveal evidence of internal trauma to the spinal disc through injection of dyes into the disc's center. Pictures of the disc taken after the dye has been injected will demonstrate "abnormal" dye patterns (abnormal nucleogram, fissuring of the annulus) when there is internal damage to the spinal disc. This information along with the patient's pain response recorded at the precise moment the dye is injected into the spinal disc will guide future treatment of the damaged disc. Discography may be necessary for surgical planning prior to a spine surgery to treat pain suspected of coming from an abnormal spinal disc. Discography may confirm or deny that the disc(s) in question are the source of the back or neck pain the patient is experiencing in their day to day life. The procedure is usually performed if the patient meets surgical criteria and the patient's pain is debilitating enough for the surgeon to consider surgery.
What are spinal discs?
Spinal discs are soft, jelly-like cushions separating the hard vertebral bones of the spine. Normally, spinal discs are not painful. A spinal disc may become painful when it is damaged (trauma). Not all damaged spinal discs seen on MRI, X-ray or CT scan are painful. In fact, roughly 30% of healthy people have one or more damaged spinal discs with no pain. Discography is a test used to determine whether or not an abnormal appearing spinal disc is generating pain.
How is the procedure performed?
Discography is usually performed at Deuk Spine Institute's surgery center as an out-patient procedure. After arrival at the surgical facility an IV
will be started. Antibiotics may be given. At the start of the discogram your physician will direct a thin needle under x-ray guidance into pre-selected spinal discs. Proper needle placement is then confirmed with an x-ray image. The selected spinal discs are then sequentially "pressurized" one at a time. A pain response is recorded for each spinal disc tested. Normal discs are not painful. Injecting a small amount of iodine contrast dye into the selected spinal discs will serve as an evocative test to determine if the spinal disc(s) in question are the source of a patient's "typical" back or neck pain.
For each spinal disc tested, the patient is asked the following question "What sensation are you feeling?" Appropriate answers include the following: 1. "Nothing" or 2. "Pressure, but no pain" or 3. "Pain". Patients experiencing pain during injection are then asked if the evoked pain is similar (same as their typical pain) or different from the pain they usually experience. The recorded pain response will aid Deuk Spine Institute physicians to determine which abnormal spinal disc(s) are the actual pain generators in that patient.
As previously stated, not all abnormal spinal discs seen on MRI will cause pain. The discogram is an excellent test to determine if an abnormal spinal disc found on MRI is painful. The entire procedure usually takes less than one hour. Patients undergoing the discography should NOT take pain medications on the day of the discography as they may interfere with the results of the test.
Is the procedure painful?
Most patients feel discomfort during parts of the procedure and some afterwards. Sedation is used to minimize discomfort. Injection site tenderness is common and usually resolves within several days. Ice packs applied for 15 minutes at a time may be used to ease discomfort.
Are there any risks or side effects from the procedure?
Risks of complication from discography is very low at Deuk Spine Institute. Known risks include infection, nerve damage, bleeding, increased pain, non-diagnostic test and headache. Rare complications include allergic reaction, stroke, vessel injury and death.
Who should not have this procedure?
If you are on blood thinner medication (i.e. Coumadin, Plavix, Aggrenox, Ticlid, or others) or have an active infection or fever, you are pregnant or trying to get pregnant, you are alergic to iodine, you should not have this procedure. The procedure may be performed after a long period of time when either blood thinning medication has been stopped, or when no active infection or fever is present. If you are pregnant, there is risk to the unborn child and you should not have this procedure. You must notify our staff prior to the procedure if you have any of these aforementioned conditions.
After the procedure...
Patients are monitored by Deuk Spine Institute staff for a short period of time after the procedure until stable for discharge home with a driver. A CT scan will be ordered immediately after the discography procedure. The CT scan can identify abnormal disc internal architecture with excellent resolution. This information is used to plan future care. Typically patients may resume full activity the next day. Pain medication will be restarted 1 hour after the discogram is complete. Soreness at the needle puncture site will resolve in a few days and application of ice packs to the area for 15 minutes at a time may help. Notify Deuk Spine Institute staff if a fever develops (101.5 degrees or higher) or you have a headache lasting longer tyhan 24 hours. Post procedure headaches usually respond well to Tylenol or Motrin, caffeinated drinks and increased fluid intake. Call Deuk Spine Institute for persistent or debilitating headaches or fever higher than 101.5 degrees as soon as possible.
Discography is a safe and reliable test used to gather very important information about the status of spinal discs in the back or neck prior to surgery. Discography is only performed when necessary. Complications are rare when a test is performed by an experienced team in an appropriate setting such as Deuk Spine Institute.
Make an appointment!