Discography

Discography

This procedure, which is sometimes referred to as a discogram, helps your doctor locate the source of back pain within your spinal discs. Discography is often an important first step when developing a comprehensive solution for your back pain management and treatment.

To begin, you lie down, generally on your abdomen or side, and are given medicine to help you relax. You will remain awake throughout the procedure, as the sensations you feel during the discography are an important part of the diagnostic test.

Your doctor will utilize a local anesthetic at the injection site to minimize the pain caused by the injection. The needle will be guided to the suspected problem discs using fluoroscope guidance. Each disc that is potentially the cause of your back pain will receive its own needle, so some patients may undergo several injections at once.

Once the needle is properly positioned it will inject dye into the disc, which will increase pressure in the disc.

If the dye injection causes the same type of back pain you experience daily, it’s likely that the disc is the culprit. An X-ray or CT scan will also be performed to track the spread of the contrast dye. The dye should stay in the center of an uninjured disc. If the dye spreads outside the center of the disc it is often a sign of wear, tear or damage to the disc.

The images and the pain sensations you experience during a discography will likely be used to determine what types of additional diagnostics you will need and where imaging should be directed to diagnose the cause of your back pain more precisely.

How long a discography takes depends on the number of discs your orthopaedist will be testing. In most cases the discography will take between 30 and 60 minutes, but the entire length of your appointment, including numbing and a short observation after the procedure, might be about three hours.

Patients may feel soreness in their back following the procedure, but pain is generally minor and temporary. Your orthopaedist may recommend using an ice pack to the test site. Patients who undergo a discography should keep their back and especially the injection sites dry for 24 hours after the procedure.

What Does a Discography Tell Your Orthopaedist?

Your own personal experience during the procedure is a vital component of this diagnostic test, which is why it’s important to be open and honest during the procedure. The pain you identify will be correlated with the testing images during the procedure to pinpoint the precise source of your back pain. This information will be used to target further non-invasive treatments and develop a comprehensive back pain treatment plan.

Without an accurate understanding of the root cause of your pain, all your doctors can do is manage the symptoms you’re experiencing. Discography can help doctors to accurately diagnose the source of your pain, which is vital to determining what to do next.

In some cases, it may be necessary to utilize additional diagnostic imaging targeted at that specific pain source, which is why a discography may lead to additional MRI or CT scans.

Are There Risks Associated with Discography?

Complications from discography are rare, and many of the potential complications are those that accompany most injection and diagnostic procedures. Rare complications include:

  • Headaches
  • Infection
  • Nerve or blood vessel injuries near injection site
  • Allergic reactions to the contrast dye
  • Exacerbation of back pain

Discography FQAs

What is Discography?
Discography is a diagnostic procedure, not a treatment. X-ray dye is injected into the spinal disc(s) and an x-ray (called a “discogram”) is taken. The discogram may be normal or may show tears (fissures) in the lining of the disc. The results of discography can be used to plan spinal surgery or IDET (IntraDiscal ElectroThermal Therapy) or Nucleoplasty.

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 become damaged (such as a fissure.)
This condition is call Internal Disc Disruption or Degenerative Disc Disease. The wall of the disc can weaken and protrude out (a herniated disc). When the disc causes pain, the pain is usually felt as a deep ache in the back and sometimes in the
buttocks and into the thigh. Pain from facet joints in the back and from the sacroiliac (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 a surgical center with fluoroscopic (x-ray) guidance. For lumbar discography it is done with you lying on your stomach. You will be given 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 performed.

What will I feel during the injection?
When a normal disc is injected, you will feel a sense of pressure, not pain. When an abnormal disc is injected, you will feel pain. It is important to try to determine if the pain you are feeling is your “typical pain” or not. When each disc is 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, your doctor will determine which disc(s) may be causing your pain. These disc(s) will be injected and evaluated. In addition, a normal disc is injected 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. Saline is also injected to reproduce the patient’s symptoms.

Will the injections hurt?
The procedure involves inserting a needle through skin and deeper tissues, 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 receive intravenous sedation and pain medication, 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 (“novocaine.”) 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. 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?
We advise patients to take it easy the day after the procedure. You may need to apply ice to the affected area for 20-30 minutes at a time for the next day. You can then perform activities as tolerated. Your doctor will provide specific activity restrictions if indicated.

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 discomfort, which is temporary. Sometimes, the discogram needle brushes past a nerve root and the nerve root is irritated. This pain gets better quickly. The other risks involve infection, bleeding, and worsening of symptoms. Fortunately, because the procedure is performed with X-ray in a controlled environment, serious side effects and complications are rare.

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, you should not have the procedure.

Learn More About Discography at Non-Surgical Orthopaedics

If your doctor, chiropractor or orthopaedic specialist has recommended undergoing a discography or other diagnostic and imaging procedures to identify the source of your chronic or acute back pain, Non-Surgical Orthopaedics can help. Patients in Marietta or Carrollton should call us at 770-421-1420 or fill out our online form for additional information on lumbar discography.

This procedure, which is sometimes referred to as a discogram, helps your doctor locate the source of back pain within your spinal discs. Discography is often an important first step when developing a comprehensive solution for your back pain management and treatment.

To begin, you lie down, generally on your abdomen or side, and are given medicine to help you relax. You will remain awake throughout the procedure, as the sensations you feel during the discography are an important part of the diagnostic test.

Your doctor will utilize a local anesthetic at the injection site to minimize the pain caused by the injection. The needle will be guided to the suspected problem discs using fluoroscope guidance. Each disc that is potentially the cause of your back pain will receive its own needle, so some patients may undergo several injections at once.

Once the needle is properly positioned it will inject dye into the disc, which will increase pressure in the disc.

If the dye injection causes the same type of back pain you experience daily, it’s likely that the disc is the culprit. An X-ray or CT scan will also be performed to track the spread of the contrast dye. The dye should stay in the center of an uninjured disc. If the dye spreads outside the center of the disc it is often a sign of wear, tear or damage to the disc.

The images and the pain sensations you experience during a discography will likely be used to determine what types of additional diagnostics you will need and where imaging should be directed to diagnose the cause of your back pain more precisely.

How long a discography takes depends on the number of discs your orthopaedist will be testing. In most cases the discography will take between 30 and 60 minutes, but the entire length of your appointment, including numbing and a short observation after the procedure, might be about three hours.

Patients may feel soreness in their back following the procedure, but pain is generally minor and temporary. Your orthopaedist may recommend using an ice pack to the test site. Patients who undergo a discography should keep their back and especially the injection sites dry for 24 hours after the procedure.

What Does a Discography Tell Your Orthopaedist?

Your own personal experience during the procedure is a vital component of this diagnostic test, which is why it’s important to be open and honest during the procedure. The pain you identify will be correlated with the testing images during the procedure to pinpoint the precise source of your back pain. This information will be used to target further non-invasive treatments and develop a comprehensive back pain treatment plan.

Without an accurate understanding of the root cause of your pain, all your doctors can do is manage the symptoms you’re experiencing. Discography can help doctors to accurately diagnose the source of your pain, which is vital to determining what to do next.

In some cases, it may be necessary to utilize additional diagnostic imaging targeted at that specific pain source, which is why a discography may lead to additional MRI or CT scans.

Are There Risks Associated with Discography?

Complications from discography are rare, and many of the potential complications are those that accompany most injection and diagnostic procedures. Rare complications include:

  • Headaches
  • Infection
  • Nerve or blood vessel injuries near injection site
  • Allergic reactions to the contrast dye
  • Exacerbation of back pain

Discography FQAs

What is Discography?
Discography is a diagnostic procedure, not a treatment. X-ray dye is injected into the spinal disc(s) and an x-ray (called a “discogram”) is taken. The discogram may be normal or may show tears (fissures) in the lining of the disc. The results of discography can be used to plan spinal surgery or IDET (IntraDiscal ElectroThermal Therapy) or Nucleoplasty.

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 become damaged (such as a fissure.)
This condition is call Internal Disc Disruption or Degenerative Disc Disease. The wall of the disc can weaken and protrude out (a herniated disc). When the disc causes pain, the pain is usually felt as a deep ache in the back and sometimes in the
buttocks and into the thigh. Pain from facet joints in the back and from the sacroiliac (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 a surgical center with fluoroscopic (x-ray) guidance. For lumbar discography it is done with you lying on your stomach. You will be given 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 performed.

What will I feel during the injection?
When a normal disc is injected, you will feel a sense of pressure, not pain. When an abnormal disc is injected, you will feel pain. It is important to try to determine if the pain you are feeling is your “typical pain” or not. When each disc is 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, your doctor will determine which disc(s) may be causing your pain. These disc(s) will be injected and evaluated. In addition, a normal disc is injected 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. Saline is also injected to reproduce the patient’s symptoms.

Will the injections hurt?
The procedure involves inserting a needle through skin and deeper tissues, 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 receive intravenous sedation and pain medication, 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 (“novocaine.”) 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. 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?
We advise patients to take it easy the day after the procedure. You may need to apply ice to the affected area for 20-30 minutes at a time for the next day. You can then perform activities as tolerated. Your doctor will provide specific activity restrictions if indicated.

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 discomfort, which is temporary. Sometimes, the discogram needle brushes past a nerve root and the nerve root is irritated. This pain gets better quickly. The other risks involve infection, bleeding, and worsening of symptoms. Fortunately, because the procedure is performed with X-ray in a controlled environment, serious side effects and complications are rare.

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, you should not have the procedure.

Learn More About Discography at Non-Surgical Orthopaedics

If your doctor, chiropractor or orthopaedic specialist has recommended undergoing a discography or other diagnostic and imaging procedures to identify the source of your chronic or acute back pain, Non-Surgical Orthopaedics can help. Patients in Marietta or Carrollton should call us at 770-421-1420 or fill out our online form for additional information on lumbar discography.

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