Discography is a diagnostic procedure in which x-ray dye (x-ray contrast) is injected into the discs of the spine. After the x-ray dye is injected, a x-ray (called a "discogram") is taken of the discs. The discogram may be normal or may show tears (fissures) in the lining of the disc. The results of discography are used to plan surgery or IDET (intradiscal electrothermal) treatment.
What is the purpose of a Discography?
Discography is done to answer the questions "Is my back pain or neck pain from a degenerated disc?" and "Which discs –if any- are causing my pain?"
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 get cracks or tears (fissures). This condition is call Internal Disc Disruption or Degenerative Disc Disease. Also, the wall of the disc can weaken and bulge out (a herniated disc). When the disc causes pain, the pain is usually felt as a deep, aching pain in the back and sometimes in the buttocks and into the thigh. However, pain from facet joints in the back and from the sacroiliac joints (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 the Operating Room with fluoroscopic (x-ray) guidance. For lumbar discography (discs in the low back), it is done with you lying on your stomach. For cervical discography (discs in the neck), it is usually done with you lying on your back. There will be an anesthesiologist or a nurse present during the procedure to monitor you and administer 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 carried out. After the injection, you are placed on your back or on your side.
What will I feel during the injection?
When a normal disc is injected, you will feel a sense of pressure, but not pain. When an abnormal disc is injected, you will feel pain. It is important to try to tell if the pain you are feeling is your usual pain or different. With each disc 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, we will identify which discs we suspect are causing your pain. These discs will be injected. In addition, we inject a normal disc 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 (x-ray contrast). It is usually mixed with some antibiotics to prevent infection.
Will the injections hurt?
The procedure involves inserting a needle through skin and deeper tissues (like a "tetanus shot"), 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 also receive intravenous sedation and analgesia, 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. Injection of a medicine like Novocaine-Lidocaine is performed to numb the skin. 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. You can be sleepy while the needles are placed, but 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?
You will a ride home. We advise the patients to take it easy for a day or so after the procedure. You may need to apply ice to the affected area for 20-30 minutes at a time for the next day. Perform the activities as tolerated by you.
Can I go to work the next day?
We usually recommend taking 2-3 days off work after the injection.
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 pain ¬, which is temporary. Sometimes, the discogram needle brushes past a nerve root and the nerve root is irritated. This pain almost always gets better quickly. The other risks involve infection, bleeding, and worsening of symptoms. Fortunately, the serious side effects and complications are uncommon.
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 going on, you should not have the procedure. You should not have discography if you have not tried simpler treatments such as activity restriction and anti-inflammatory medications.
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