Lumbar Discography
Discography is a test used to determine whether the suspected disc (clinical exam and radiological findings) is the true source of pain in patients with predominantly axial back or neck pain (DDD, IDDS). During the procedure, x-ray contrast (dye) is injected into the suspected disc as well as adjacent “normal” looking discs. Next, the patient’s response to the injection is noted. If the test reproduces your typical, daily back or neck pain, this suggests that the disc is likely the source of the pain.
A CT scan must be performed immediately after the discogram to better assess the anatomical changes in the disc. For the test to be valid, the CT scan must reveal contrast leaking into tears on the inside of the disc; thus demonstrating the expected disruption of the annular fibres.
Specific indications for discography include the following:
- Persistent, severe symptoms when other diagnostic tests have failed to clearly confirm a suspected disc as a source of the pain.
- Evaluation of recurrent pain from a previously operated disc.
- Assessment of patients in whom spine surgery has failed to provide relief.
- Assessment prior to spinal fusion surgery to identify symptomatic discs. Also, the surgeon may want to know whether the discs adjacent (next to) to the segment can support the stress of fusion.
- Assessment of candidates for minimally invasive procedures such as percutaneous discectomy (disc herniation), or intradiscal modulation (internal disc disruption syndrome)
Common complications associated with discography include: nausea (2%), seizures (4%), headache (10%), and increased pain (81%). Rare, but serious complications include spinal headache, meningitis, discitis (disc infection), arachnoiditis (scarring), allergic reaction, and bleeding.
Injection Procedure — Discography: In contrast to diagnostic “blocks”, the goal of provocative discography is to replicate the patient’s typical discomfort (symptoms). The patient’s experience is similar to the that of a typical diagnostic block, until the final step:
- Brief, mild discomfort (one or two seconds) from the local anesthetic (numbing medication) placed at the skin site (like getting a tooth frozen at the dentist).
- Little to no discomfort when directing the spinal needle to the target
- Once the needle has reached the target site, inside the disc, they will typically feel one of two sensations as the contrast (x-ray dye) is instilled into the middle of the disc:
- If the disc is not a source of pain, they may feel absolutely nothing or they may feel pressure.
- If the disc is their source of pain, they will feel moderate pain that replicates their daily pain experience (re-creates “your” pain).
Video: Discography
Click below to view a video from our library about this procedure.