Discogram

Interventional Radiology

A Discogram is used to determine if the source back pain is due to one or more abnormal intervertebral discs. Discograms are usually performed to help physicians decide if corrective procedures or surgery is feasible and on which level(s) it should be performed. This test is often needed because CT or MRI evaluation of the spine is inconclusive, does not correlate with the clinical findings, or shows multiple abnormalities which need to be sorted out to determine which ones are causing pain.

During a Discogram, a small diameter needle is placed into the center of a vertebral disc and a small amount of fluid is injected, which can be seen on the X-ray fluoroscope. This places controlled pressure on the disc. A normal disc is unaffected but a disc which has been causing pain will start to reproduce the patient’s same pattern of pain. At least several adjacent discs are injected, giving the physician a better idea of which are responsible for the current symptoms.

The procedure is done with intravenous pain and sedative medication to keep the pain from becoming severe. Other causes of nerve irritation, such as a bone spur, do not respond to disc injection thus helping decide if the pain is arising from an abnormal disc or other cause. Discography can also detect pain arising from small tears in the annular ligament holding the disc in place. These can allow irritating fluid from the disc to leak along the nerve root and can be hard to visualize on MRI or CT scans.

What to Expect

Patients should ensure that previous imaging studies have been sent either to Advanced Medical Imaging or the hospital and received. The procedure cannot be done without them. Patients should inform the scheduling staff if they are taking blood thinners, have medication or other allergies, or have other significant health problems. Patients should not to eat or drink after midnight before the procedure. Patients will need to bring a driver as they will not be able to drive home after receiving intravenous medications. A routine laboratory blood check may be needed if one has not been performed recently.

Discograms usually take about an hour with another hour or two in the recovery area. During the procedure patients will receive medication for pain relief and sedation intravenously (via an IV). Patients will also be given antibiotics to prevent a disc space infection. The response to discography varies considerably. Some patients find it painful while others have very little discomfort. AMI providers do everything they can to individualize treatment and make the procedure as comfortable as possible.

Immediately afterwards, a CT scan may be taken so that the anatomy of the disc can be better appreciated. The results will be discussed with the patient before they leave and a report will be forwarded to their physician. On the day of the injection, patients should not drive and should limit activities. Over the next 2-3 days, muscles may be sore and the usual pain may be aggravated. Ice will usually be more helpful than heat during this period. Regular pain medicine can be taken as prescribed. On the second to third day, patients may return to regular activities. Soreness should improve by the third day and pain should go back towards the baseline level. When pain is improved, patients should start their regular exercises/activities in moderation.