What is a discogram? A discogram is
a test which is typically done by a pain management specialist or radiologist.
The purpose of this test is to help your surgeon (orthopedic surgeon or
neurosurgeon) determine which disc, if any, is causing your pain. There are
many causes of neck and shoulder pain and even headaches which can relate to
the cervical spine. There are also many causes of low back pain, only some of
which relate to the lumbar discs. Your surgeon is hoping to find the
"pain generator" or cause of your pain. While CT, MRI and x-rays can
be very helpful for finding anatomic changes, they cannot definitively
determine that this pathology or these anatomic changes in the cervical or
lumbar spine are actually causing pain. In some cases, large discs can cause
minor discomfort; in other cases, disc degeneration or small protrusions can
cause excruciating and disabling pain. In some cases, small defects in the
outer disc (called the annulus) can be very associated with instability. This
instability can be very painful and cause neck, back or even extremity pain.
This instability and outer disc or annular tears can often be missed with
routine studies such as MRI, CT, myelogram or X-RAY.
Discography is the only test known to correlate pain generation with disc
abnormalities. By determining which disc or discs are causing your pain, your
surgeon can more accurately prescribe treatment or surgery. In other cases,
surgeons may use discography to eliminate the disc as a cause of pain, thus
avoiding a surgery which is not likely to be helpful.
There has been some controversy
regarding discography in the scientific and medical literature. Current
techniques of discography, particularly when performed by a qualified pain
management specialist or neuroradiologist , can be combined with your surgeon’s
clinical expertise and other tests to dramatically improve the likelihood of
successful surgery, if this is prescribed by your doctor.
IS DISCOGRAPHY PERFORMED?
Until recently, most discography
was performed by a radiologist. Discography is typically performed by providing the patient enough
sedation so that he or she feels minimal discomfort during needle placement in
the center of the disc. If need be, the patient can even be completely
"asleep" or so deeply sedated that there is no knowledge of the
needle placement. Following the placement of the needles, using an x-ray
machine called a fluoroscope for precise guidance and safety, a type of
medication called an antagonist is given for the purpose of awakening you
completely. There is no problem with being "sleepy" or
"asleep" while the needles are placed. It is imperative that you are
later wide awake and alert so that you can answer questions when a type of
contrast dye called Isovue is injected into the disc.
Typically, injecting this
medication, or dye, into a normal disc is painless. The purpose of the
discogram is to determine if the injection of dye or pressurization of the
disc reproduces or replicates the patient’s typical pain complaints. If the
pain is replicated or duplicated, this discomfort is typically called
concordant. The existence of concordant pain is association with an abnormal
disc which reveals a herniation or tear in the outer disc would signify that
the discogram is positive. This is very critical information for your surgeon
and will help him plan your treatment. The absence of pain or a
normal-appearing disc under fluoroscopy may have other implications for
treatment that can be discussed with your surgeon or with the doctor
performing the discogram.
CAN YOU EXPECT UPON ARRIVING AT THE FACILITY FOR DISCOGRAPHY?
It is important
that you have absolutely nothing to eat or drink except for small amounts of
clear liquids for eight hours before your discogram. This is because we will
be giving you a sedative so you are not uncomfortable during the placement of
the needles. An IV will be started by a nurse or an anesthesiologist, and you
will be brought into a room where you will be positioned comfortably under the
x-ray machine/ fluoroscope. If it is a cervical discogram, you will be lying
on your back. If it is a lumbar or thoracic discogram, you will be prone, or
on your stomach. Typically, a discogram will take approximately 20
minutes; however, complicated cases or those in which the patient has
undergone prior surgery can take an hour or more.
One should expect a three- to four-hour stay in the Ambulatory Surgery
Facility for paperwork, premedication, and post- procedural observation.
Some postdiscographic discomfort is
unavoidable; however, you will be provided with adequate pain relief so that
you are comfortable in the postdiscographic period. You may be given a
prescription to go home with.
ARE THE POSSIBLE COMPLICATIONS OF DISCOGRAPHY?
complications of discography are extremely rare. The most common side effect
is somewhat increased discomfort for a few days after the discogram. There is
an extremely unlikely possibility of nerve root irritation or injury,
infection or spinal headache. There is an extremely low likeli-hood of other
complications, including discitis; however, the possibility of severe,
disabling injury is much lower with discography than with any surgical
procedure involving the spine.
Your doctor will take special care to make sure that you are safe and that
you receive antibiotics to prevent infection, and meticulous care will be
taken to avoid any kind of neurologic injury or unnecessary discomfort.