A Lumbar Discogram, also referred to as a Lumbar provocative discography, is a minimally invasive procedure that is used to determine the condition of the intervertebral disc in patients experiencing severe and chronic lower back pain. When surgical intervention is a consideration such as for a spinal fusion or artificial disc replacement for end-stage degenerative disc disease, a lumbar discogram is often performed to confirm the disc is the source of one's back pain.
What conditions are treatable with the Lumbar Discogram procedure?
The Lumbar Discogram is not a treatment but rather it is a diagnostic procedure. It is used to determine the condition of the intervertebral discs in patients who have shown on an MRI to have serious degenerated discs in order to determine if surgical intervention iwill be beneficial to the patient.
It is simply one of the diagnostic tools available to the Chicago pain management doctor to help confirm the specific lumbar disc as the true source of back pain and help make sure the surgery has the best chance of success.
What are the expectations when a patient gets a Lumbar Discogram?
Due to the nature of the procedure a patient can expect to experience pain, often at higher levels than regularly experienced on a day to day basis. This is because the procedure is used to determine which intervertebral disc(s) are causing the patient's chronic pain.
In actuality, the discogram is intended to reproduce the pain a patient is experiencing on a daily basis by injecting fluid into that degenerative disc.
How is the Lumbar Discogram performed?
The Lumbar Discogram procedure is performed by having the patient lie on an examination table on their side or face down. Their vital signs will be monitored and he or she is given a sedative and possibly an antibiotic as a precaution to infection.
The area(s) to be examined are cleansed with antiseptic solution and with the aid of a fluoroscope (a type of x-ray machine) needles are inserted into the discs being examined. A contrast dye is then injected into the discs; the injection of this dye raises the internal pressure of the disc and often causes the patient to experience discomfort or pain. If pain is experienced it is highly likely this disc is the cause, or part of the cause of the patients pain.
The patient is not "knocked out" for the procedure. The reason is the pain management doctor in Chicago needs to know if the pain experienced is the same as that typically seen on a daily basis. If it is, that is a positive discogram.
The levels above the suspicious disc are also injected as controls. These discs should provoke some pain, but it should not be similar to what is experienced on a daily basis. If it is and that is a normal looking disc on an MRI, then it speaks against the test being positive.
After the dye has been injected an x-ray or CT scan is performed to see if the dye remained in the center of the disc or if it spread out. If it remains within the center of the disc the disc is fairly normal, if however, the dye spreads, the disc is damaged.
How long does the procedure take?
The procedure typically takes between thirty minutes to one hour, followed by an observation period. Since it is performed on an outpatient basis patients go home the same day but will need someone to drive due to the sedation.
What risk or side effects are there?
Risks and side effects are minimal, however there is the likelihood that one will experience pain during the procedure as that is what the procedure is looking for. One may experience bruising, swelling, and bleeding from the injection sites and may be sore for a few days after the procedure. Since the needles are placed using fluoroscope guidance risk is small, but there is the potential for nerve damage.
There has been speculation that a discogram may lead to further disc degeneration. However, this has never been definitively proven.
How successful is the procedure for the relief of pain?
A Lumbar Discogram is a diagnostic procedure and is not intended for pain relief.
Bottom line on this procedure?
For patients experiencing chronic back pain, the Lumbar Discogram may be necessary to determine treatment or if surgical intervention is required. If your Chicago pain management specialist feels you may need surgery, the procedure may be exceptionally helpful.