Discogram
What is a discogram?
A discogram is a diagnostic procedure for disc related injury or disease. Briefly, the procedure is basically an injection of contrast dyeinto the discs of your spine. It is done under precise x-ray guidance. After the dye is injected, a special x-ray, called a discogram, is taken of the discs. We want to know whether the discs in the back are normal or whether they show tears, fissures or other damage. Our findings are then used to plan treatment protocol.
What is the purpose of a discogram?
When we do a discogram, we want to answer two main questions: “Is our patient’s directly caused by a torn or damaged disc?” and “Which exact discs are responsible for the pain?” A discogram is a diagnostic procedure. It will give us the information we need to plan a treatment protocol.
How do I know if my pain is from a damaged disc?
Anybody who has experienced pain from a damaged disc understands the intensity of pain it can cause. These flat, circular discs are firmly embedded between adjacent vertebral bodies of the spine, allowing them to act like “shock absorbers.”
As we age or if we are injured, the outer wall of the spinal discs can become dehydrated, get cracks in them or even tears and fissures. This condition is called degenerative disc disease.
The wall of the disc can also weaken and bulge outward, occasionally bulging far enough to cause a disc herniation. Disc related neck pain is often felt in the neck, upper back, shoulders and arms. Disc related pain in the lower back can cause deep pain in the low back, hips, buttocks & thighs, all the way down to the calves and feet.
However, pain from other structures in and around the spine such as your facet joints or muscles may cause very similar pain in the same locations.
Therefore, a discogram can sometimes be useful to tell if the pain is directly from a damaged disc.
How is a discogram actually performed?
The procedure is performed with fluoroscopic x-ray guidance under sterile conditions. You will likely also receive intravenous antibiotics before the procedure. Depending on the disc being injected, you may either be lying on your belly (thoracic or lumbar discs) or your back (cervical discs). You will be monitored and receive sedation to keep you comfortable during the procedure.
Your skin overlying the injection site is cleaned with an antiseptic solution. After numbing the skin with a local anesthetic, a needle is guided to to the targeted disc under x-ray guidance. Once in place, contrast dye is is injected. Because you will be answering questions from your physician regarding your pain symptoms during the procedure, you will be sedated, but awake enough to answer. After the information is obtained, all needles are removed and a band-aid at the entry site is applied.
What will I feel during the discogram?
When the targeted disc is normal and without injury, you will likely feel pressure during the injection, but not pain. However, when an injured disc is injected, you will feel sharp pain.
You will be asked during the procedure to describe your pain and whether or not it is the same as the usual pain you have been feeling prior to the procedure.
How many discs will be injected?
Based on your history of symptoms, your physical examination and your MRI findings, we will diagnose the discs we suspect that may be causing your pain. During a discogram, we often do not inject more than 2 or 3 discs in any one procedure.
How long does a discogram take?
A discogram takes an estimated twenty minutes per disc, with the total time depending on how many levels are injected.
What is actually injected?
Contrast dye, which can be seen under x-ray is injected into the suspected injured discs. We often mix in antibiotics (to prevent infection), local anesthetic (for pain control) and occasionally steroids (to minimize inflammation) as well.
Will the discogram hurt?
A discogram involves accurate needle placement in the spine, which requires going through the skin. To maximize your comfort, however, can we give you intravenous sedation and give local anesthetic at the skin and in deeper tissues, making the entire procedure much easier to tolerate.
Will I be “put out” for the discogram?
No. A discogram is done under local anesthesia (numbing medicine) and intravenous sedation. The intravenous medication is titrated so that you can be deeply sedated while the needle is being placed, but more awake during the disc injection to answer the doctor’s questions. Some patients actually will experience amnesia and may not remember some, or any, parts of the procedure.
Will my pain be better after the discogram?
No. A discogram is diagnostic, not therapeutic. It does not treat or heal your condition. In fact, you may have a flare-up of your back pain immediately after the injection, which often improves with time, ice packs and oral medications.
What should I do after the discogram?
On the day of your discogram, please have a designated driver to take you home. You will take it easy and rest for the remainder of the day. We recommend you only perform light activities that you can tolerate. After a day or so, you may increase your activity level slowly.
Can I go to work to work the next day?
Most patients are recommended to take 2-3 days of physical rest after the injection.
What are the risks and side effects of a discogram?
Overall, this procedure is safe. However, with all procedure there are basic risks, side effects and a possibility of complications. The most common side effect is pain at the injection site. On rare occasion, other risks involve bleeding and infection. Although serious side effects and complications are fortunately very rare. Nerve irritation, infection, bleeding or worsening of symptoms are amongst examples of rare complications. Infection of a disc, also known as discitis, is a more serious complication and must be treated with longer term antibiotics.
Who should not have a discogram?
Prior to your procedure, we will determine if you are a candidate for a discogram. There are some instances where you may not be a candidate for this procedure. If you have a history of an allergic reaction to any of the medications we would be injecting, you may not be a good candidate. If you are on blood thinning medications, have an active infection going on, or have unstable disease like poorly controlled diabetes of heart function, you may be at increased risk for a complication and we may consider postponing or cancelling your procedure.
In general, most patients should not have a discogram without having tried simpler treatments such as rest, medication, physical therapy or other types of injections.