OrthoNeuroSpine & Pain Institute
Discography is a test that looks at the spine to locate specific areas that are causing pain.
Discography uses a dye and X-rays to look at your spine and find any specific areas that are causing pain.
Your spine is made up of bones called vertebrae. They are separated by strong connectors called discs, which are made up of a type of connective tissue called cartilage. These discs act as shock absorbers and allow your spine to bend. Your spinal cord runs through the middle of each vertebra, carrying nerves from your brain to the rest of your body.
Your discs can become worn or they may split and slip in between your vertebrae. This condition is known as a herniated disc. Some herniated discs put pressure on your nerves and can cause pain or numbness in your legs.
A discography can find out which disc, if any, is causing your pain. It's usually only done if simple measures have failed to control your back pain and other tests such as an MRI scan haven't been able to identify the cause of your pain. Discography can help your doctor to plan surgery or other treatments.
Preparing for discography
Your doctor will explain how to prepare for your test.
You may be asked not to eat for a few hours before the discography. Follow the instructions given to you by your doctor.
Your doctor will discuss with you what will happen before, during and after your procedure, and any pain you might have. This is your opportunity to understand what will happen, and you can help yourself by preparing questions to ask about the risks, benefits and any alternatives to the procedure. This will help you to be informed, so you can give your consent for the procedure to go ahead, which you may be asked to do by signing a consent form.
What happens during discography
Discography is usually done in the X-ray or radiology department of a hospital. It takes between 30 and 45 minutes.
You will have a small plastic tube (cannula) placed into a vein, usually in the back of your hand. You may then be given a sedative medicine through the cannula, and other medicines if necessary. Sedatives relieve anxiety and help you to relax. You may also be given a dose of antibiotics to help prevent infection.
You will usually be asked to lie on your side or get into the prone position (lie face down) on the X-ray table. Your doctor may then give you an injection of local anaesthetic into the skin on your back to block pain from the area.
A special dye called contrast medium will be injected into the centre of each disc and X-rays will be taken. While this is being done, you will be asked to rate any pain or pressure you feel, usually on a scale of zero to 10. You will also be asked where the pain is and whether or not it is similar to your usual pain.
You may have a CT scan after your discography. A CT scan uses X-rays to make a three-dimensional image of your spine. A CT scan allows your doctor to see if there have been any changes in the size or shape of your discs.
What to expect afterwards
You will be able to go home when you feel ready. You will need to arrange for someone to drive you home.
Your doctor will review your test results and explain them to you at a follow-up appointment. Generally, if the X-rays show the dye has stayed in the centre of your disc, this means it is normal. However, if the dye has spread throughout your disc, or has leaked away, this means it may be damaged.
The test can help provide a better understanding of your back problem and your doctor will then be able to offer you suitable advice and treatment.
Recovering from discography
Sedation temporarily affects your co-ordination and reasoning skills, so you must not drive, drink alcohol, operate machinery or sign legal documents for 24 hours afterwards. If you're in any doubt about driving, please contact your motor insurer so that you're aware of their recommendations, and always follow your doctor's advice.
You may have some pain after the procedure. If you need pain relief you can take over-the-counter painkillers such as paracetamol or ibuprofen. Always read the patient information leaflet that comes with your medicine and if you have any questions, ask your pharmacist for advice.
Try to take it easy for the rest of the day. You must follow your doctor's advice about returning to work and getting back to your everyday activities.
What are the risks?
As with every procedure, there are some risks associated with discography. We have not included the chance of these happening as they are specific to you and differ for every person. Ask your doctor to explain how these risks apply to you.
Discography involves having X-rays, which exposes you to radiation. The amount of radiation you have will depend on the number of X-rays you need and whether or not you have a CT scan after the discography. The benefits of you having this test should outweigh the risk related to the level of radiation you receive.
Side-effects are the unwanted but mostly temporary effects you may get after having the test.
After the discography, you may have some pain or muscle spasms where you had the injection. Some people also have a headache or feel sick.
Complications are when problems occur during or after the test.
Complications of discography are rare. They include:
- infection in one of your discs
- damage to the nerves in your spine
- an increase in your back pain
- an allergic reaction to the contrast medium
If you're pregnant
Although the radiation dose used during a discography is generally thought to be safe for adults, it may harm an unborn baby. If you're pregnant, or think you could be, you must tell your doctor before your discography appointment.
Why is a discogram done?
Although an MRI or CT scan can strongly suggest which disc might be generating pain, these studies do not always precisely identify the pain generator. A disc can appear abnormal on a scan, but it may not be causing pain. Furthermore, some patients have more than one abnormal appearing disc on a scan, and the treating physician may want to determine if pain is coming from one or both of these abnormal appearing discs for the purpose of planning surgery or some other treatment.
Most patients who require a discogram have failed to improve with conservative treatments, including medications, physical therapy, and injection therapy. Since your doctor wants to address all of the painful discs in your spine, a discogram has been recommended. Once the painful disc is identified, it can then be treated.
Treatment options for a painful lumbar disc can include minimally invasive intradiscal procedures like Percutaneous Disc Decompression or IDET (Intradiscal Electro-Thermal Coagulation). Alternately, surgical treatment may be indicated. The choice of treatment for a discogram-positive painful disc is determined by a number of factors that your doctor will discuss with you when the time is appropriate.
How is this procedure done?
Discography is a relatively brief 30-45 minute outpatient, X-Ray guided procedure that is performed under local anesthesia. Sterile technique is utilized to minimize the risk of infection. You will be lying on your stomach during the procedure, just as you may have done with an epidural steroid or facet joint injection procedure. For a lumbar discogram, two to four discs are typically studied. The physician numbs the skin and soft tissue overlying each disc with a local anesthetic like Lidocaine. The doctor will then place a small needle into the center of each disc and inject some radio-opaque dye. An X-Ray is then taken to view the disc anatomy and to see if the dye leaks out of the disc. In addition, the pressure within each disc is measured during and after dye injection. Most importantly, the patient’s response during dye injection will tell the physician if he is reproducing that patient’s typical pain symptoms, different pain symptoms, or no pain at all. Occasionally a CT scan is obtained immediately after the discogram to look more closely at the pattern of dye spread through the disc. CT can be helpful in diagnosing a tear or disruption in the outer layer (annulus fibrosis) of a disc. All of this information is used to determine if a patient has a painful disc and which treatment is appropriate.
Does this procedure hurt?
If the cause of your typical symptoms is a painful disc in your spine, then this pain will likely be reproduced during disc stimulation. It is extremely important for you to be awake enough to tell your doctor what you are feeling during this procedure. Patients who are sedated or drowsy during disc stimulation may be unable to provide the physician with reliable information during disc stimulation. Therefore, in order to preserve the validity of discogram results and to ensure that the correct information is gathered for treatment decision-making, very little or no sedation is administered during this procedure.
What should I do to prepare for my procedure?
On the day of your injection, you should not have anything to eat or drink for at least eight (8) hours before your scheduled procedure. You must have someone available to drive you home. If possible, you should shower and use an antibacterial soap like Lever 2000 before your procedure. If you usually take medication for high blood pressure or any kind of heart condition, it is very important that you take this medication at the usual time with a sip of water before your procedure.
If you are taking any type of medication that can thin the blood and cause excessive bleeding, you should discuss with your doctors whether to discontinue this medication prior to the procedure. These anticoagulant meds are usually prescribed to protect a patient against stroke, heart attack, or other vascular occlusion event. Therefore the decision to discontinue one of these medications is not made by the pain management physician but rather by the primary care or specialty physician (cardiologist) who prescribes and manages that medication. Examples of medications that could promote surgical bleeding include Coumadin, Plavix, Aggrenox, Pletal, Ticlid, and Lovenox.
What should I expect after the procedure?
Most patients will experience a mild to moderate increase in back pain after discography. This typically lasts for a day or two, and then the pain will return to baseline.
What should I do after my discogram?
Following discharge home, you should plan on simple rest and relaxation. If you have pain at the injection sites, application of an ice pack to these areas should be helpful. You should not drive a car for at least one full day. Patients are generally advised to go home and not return to work until the next day.
Could there be side effects or complications?
Modern medicine has improved safety with every aspect of patient care, but there is no guarantee of a perfect outcome with any test or procedure. Fortunately the side effect and complication profile for discography is very low. The doctor will discuss this issue with you before the procedure.
Do I ever have to have a discogram done again?
Probably not. Discography is generally a one-time experience. The results of this test will usually be either positive or negative. A patient’s treatment plan is often solely determined by the results of this procedure. Your doctor will let you know what was found during the procedure as well as the next step in your treatment plan.