FAQs on Discogram/ Discography
Discogram, also known as discography, is an investigated technique to determine if pain is originating from a disc. First described in 1948, the diagnostic method is used to examine intervertebral disc pathology in patients experiencing back and neck pain. Over the years, lumbar provocative discography has become a popular way to identify suspected discs responsible for persistent lower-back pain.
What is discogram?
Discogram refers to a radiodiagnostic procedure to evaluate structural integrity of a disc and determine if it is the source of neck and back pain. Performed under real-time x-ray or fluoroscopic guidance, discography is done to find out a “pain generator” disc. The procedure helps in planning surgical and non-surgical treatment for back and neck pain.
When a discogram is performed?
Discogram is performed to
- determine if the neck or back pain is due to a degenerated or damaged disc, and
- find out the disc responsible for back or neck pain
An intervertebral disc, made of fibrocartilengous tissues, lies between two vertebrae. It acts as a cushion and absorbs shock to prevent injury to the spinal column. When the disc is damaged, weakens or bulges out, it causes deep aching pain that gradually radiates to the surrounding areas. But it is not easy for doctors to find out the actual source of pain, as other structures in the pain area may be the reason. Discogram helps confirm if pain is due to a disc problem and the location of the damaged disc.
Who is a candidate for discogram?
A patient is suggested t undergo discogram investigation procedure when
- there is persistent spinal pain
- doctors suspect disc abnormality leading to pain
- non-invasive tests fail to clarify the source of back and neck pain
- a correlation between pain and disc is established
Who should not have discogram?
- known allergy to dye and medications, iodine or shellfish injected during the procedure
- ongoing infection
- yet to try other non-invasive treatment methods
- prescription of blood-thinning medication
How is discogram procedure performed?
Discogram involves injection of dye under real-time x-ray to indentify structural abnormality in a disc. Patients are advised to stop certain medications, especially NSAIDS, before the procedure, which is performed under local anesthesia. Doctors may administer intravenous sedation to make parients more comfortable.
For lumbar or low-back discogram, patients are asked to lie on their stomach. In case of cervical or neck discography, patients lie down on their back.
The skin above the targeted area is numbed using a local anesthetic. A needle is inserted into the suspected disc under fluoroscopic guidance. A radiopaque dye is put into the needle. Doctors observe the dye pattern to see if there is any structural abnormality in the disc.
What is injected during discogram diagnostic procedure?
The injection has a mixture of x-ray contrast and antibiotics. The contrast is vital to identify any rupture or disruption in the disc wall. Antibiotics help prevent infection.
How long does a discogram procedure take?
It takes about 45 minutes to perform a discogram.
How many discs are examined?
The discogram procedure is performed to ascertain the condition of one or more discs as required.
How is discogram result understood?
If a disc is found to be damaged or structurally disrupted, that is identified as the source of pain and treatment method is prescribed accordingly. If no damaged disc is located, other potential sources of pain are investigated in the light of symptoms using differential diagnostic techniques.
What should I expect after discogram injection?
Patients feel pain when a disrupted disc is injected. The procedure is easy and well tolerated and patients are discharged after one or two hours. There may be inflammation, numbness or flare-up at the injection site for up to 48 hours. This can be overcome with ice therapy.
Is there any pain relief following discogram?
Patients do not experience any pain relief after having discogram, as it is only a diagnostic procedure.
What cautions should I follow after discogram procedure?
Apply ice pack on the injection site two to three times a day. It is recommended to take rest for the rest of the day. Do activities only you can tolerate. Avoid driving or operating heavy machinery for a day.
How effective is discogram diagnosis?
- Discogram procedure is more successful compared to MRI in detecting intervertebral disc ruptures. (Acta Ortopedica Mexicana, 2007)
- Discography helps determine pain following intervertebral disc degeneration and plan in the treatment. (Current Reviews in Musculoskeletal Medicine, 2008)
- Discogram effectively determine “to confirm or refute the hypothesis that a specific lumbar disc is the predominant source of a patient’s low back pain.” (Physical Medicine & Rehabilitation Clinics of North America, 2010)
What are the side effects of discogram procedure?
Discogram injection may result in damage to nerves or irritation of nerve roots unless performed by a specilist. Injection-site infection is another risk.
Premier Pain & Spine in Chicago offers lumbar discogram procedures at several locations. The procedure takes significant skill so that the outcome may be properly interpreted. By being Board Certified and Fellowship Trained, the providers routinely provide expert discography.
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Bogduk N, Modic MT. Lumbar discography. Spine 1996 Feb 1;21(3):402-4.
Cohen SP1, Larkin TM, et al. Lumbar discography: a comprehensive review of outcome studies, diagnostic accuracy, and principles. Reg Anesth Pain Med. 2005 Mar-Apr;30(2):163-83.
Manchikanti L, Glaser SE, Wolfer L et al. (2009). Systematic review of lumbar discography as a diagnostic test for chronic low back pain. Pain Physician, 12(3): 541-559.