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DISCOGRAPHY: PATIENT INFORMATION

 

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.

 

HOW 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.

 

WHAT 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.

 

WHAT ARE THE POSSIBLE COMPLICATIONS OF DISCOGRAPHY?

 

The possible 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.

 

 

 

 

 

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