Discogram

 

The lumbar discogram procedure is done purely for diagnosic purposes. The disk will be numbed in order to see if the injected disk is the pain generator. After a short period of time, the pain WILL come back.

While different discographers may vary the procedure slightly, the following provides an overview of modern technique for a lumbar discogram diagnosing back pain.

History and Physical Exam

A nurse or other healthcare professional conducts the initial interview. All of your questions and concerns should be addressed and answered. This is the time to relate any and all horror stories you may have heard from medical (and non-medical) experts. Despite what you’ve been told, the discogram is not designed to create agony.

Next, the discographer will talk with you to review the relevant anatomy and discuss the procedure in much greater detail. You now have a second chance to ask questions or decide whether or not to proceed.

Initial Preparation for the Discogram Procedure

If you agree to allow the discographer to perform this exam, an intravenous line is started just in case intra-procedural medications become necessary. Usually, sedation is avoided so as not to interfere with any reactions or sensations you may experience.

Next, you are placed on a specialized table around which a fluoroscopic (x-ray) unit is positioned. Your back is then marked with an ink pen over the disc spaces that will ultimately be examined. Then your back is thoroughly cleansed and sterile drapes are applied. The fluoroscope will also be sterilely draped and the discographer will be in a sterile surgical gown.

Administration of Local Anesthesia

The goal is to anesthetize a core of tissue that extends from your skin to the disc surface. When these tissues are numbed a guide needle is directed towards the disc and will just touch the outer surface of the annulus (the outer margin of the disc).

Through this guide needle a much smaller disc needle is advanced towards and eventually into the center of the disc. This process should not be painful, but sometimes may be. The next step is to inject lidocaine into the disk, numbing it.

The discogram procedure usually takes about fifteen minutes to perform. You’ll have soreness from the needle punctures that lasts several days. You may use acetaminophen, ibuprofen or apply an ice pack for a few minutes to ease the soreness. Some physicians prescribe short term narcotic pain medications for use after the procedure.

Possible Risks and Complications of a Discogram

As with any other invasive test, there are associated risks and possible complications.

The most feared complication is a disc space infection, which can be very difficult to treat. Fortunately, by using very strict sterile techniques this is a very uncommon complication. To help reduce this, we give our patients antibiotics during the procedure.

There are extremely remote possibilities of nerve root injury

Spinal headache is also a remote risk

With a skilled and experienced discographer who uses modern discography techniques, all of these risks are very rare.

In summary, a discogram is a preoperative study designed to determine if an intervertebral disc is a pain generator. The initial needle placement need not be painful. If pressurization of a disc causes a familiar pain, then surgical obliteration (fusion) of the pain generator(s) may afford significant back pain relief.

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