Discogram as a Spinal Diagnostic Test
Discography is performed to determine if one or more intervertebral discs are contributing to or causing your back pain and leg pain. Discogram is another term for discography. It is an invasive procedure performed using fluoroscopic guidance (real-time x-ray) for precise needle placement. Through the needle, a small amount of contrast dye is injected. As the contrast is injected, the pressure increases within the disc. Increased intra-discal pressure may replicate your symptoms (eg, leg pain). Discography may be uncomfortable, but it may provide valuable information that helps the physician pinpoint the pain-generating disc.
Why Your Physician May Order Discography
Each intervertebral disc is a cushion-like structure between 2 vertebral bodies. Discs enable motion in your spine, and they absorb and distribute shock and pressure through the spinal column while you’re moving.
Although discs are made of sturdy fibrocartilage, they are susceptible to excessive shock, pressure, strain, and injury. A disc can bulge or herniate, potentially compressing the spinal cord and/or nerve roots. Degenerative disorders usually associated with normal aging (eg, degenerative disc disease) may contribute to the development of a disc problem.
Although your physician may have performed other imaging test, such as x-ray or CT scans, discography can provide more information than those tests. During discography, the physician can assess the internal structure of targeted discs. The contrast dye that is injected into these discs highlights structural aspects—including abnormalities, and this is important to making an accurate diagnosis. The results of discography can be used for spine surgery planning, too. (As a reassurance, though, undergoing discography does not automatically mean you need spine surgery!)
Potential Discography Risks
Any medical procedure has risks. Talk with your physician about your potential risks. It is the best way to be well-informed. Before the discography procedure, you will be asked to sign a procedure consent form.
Potential risks include:
- pain may increase for a short time after discography
- nerve injury
- allergic reaction(s)
It is important you make sure your physician is fully informed about allergies you have and medications you take. Other important information you need to share includes items listed below.
Tell your physician about:
- previous reaction(s) to x-ray dye or iodine
- prescription medications (name, dosage)
- over-the-counter drugs
- vitamins, herbs and supplements
- history of blood clots, bleeding problems
- previous spine surgery(ies)
- recent cold, flu, or fever
- being pregnant (or possibly pregnant)
Your physician will give you instructions about how to prepare for the test. The instructions listed below may not apply to you. Please keep in mind that no 2 patients are the same, and your instructions may include or exclude items listed. Talk with your physician!
- Stop taking certain medications, as instructed by your physician.
- If possible, stop taking non-steroidal anti-inflammatory drugs (NSAIDs) for 10 days before discography. Aspirin or NSAIDs may increase your risk of bleeding.
- The night before your test, do not eat or drink after midnight.
- Reduce pre-procedure stress by arriving early.
- Arrange for someone to drive you home.
What to Expect During Discography
- A member of the radiology staff asks you to change into a gown.
- An IV (intravenous) line is started in your arm, and a medication to help you relax is administered.
- You are positioned on the fluoroscopy bed on your side.
- You are awake during the procedure.
- During discography, your breathing, heart rate, blood pressure, oxygen level, and temperature are closely monitored.
A local anesthetic (numbing medicine) is injected into the skin areas over the discs. Next, a needle is guided using fluoroscopy into the center of the disc being tested. Contrast dye is injected through the needle into the disc, and the pressure can be measured.
Throughout the procedure, you speak with the physician and report your symptoms compared to those you usually experience. A CT scan is taken. If contrast dye is leaking out of the disc, it will be seen on the CT scan. When the test is over, the needle(s) are removed and the area is covered with a small dressing.
In the recovery area, your vital signs will continue to be closely monitored. Pain is one of your vital signs, and if you experience post-procedural pain, medication is administered. You are released to go home with instructions for home care when the physician determines you are ready.
Home care following a discogram:
- Pain may increase for 24 to 48 hours after discography.
- You may experience sore muscles.
- Take pain and other medications as prescribed by your physician.
- Take it easy the first 48 to 72 hours after your procedure.
- Resume normal activities slowly and as tolerated.
Seek medical care if:
- pain medications do not control pain.
- pain suddenly becomes severe.
- you develop a fever greater than 100.5°F (38.1°C).
- leg pain increases.
- you have difficulty controlling your bowels or bladder.
Your physician will discuss the discography results with you, and he or she will be available to answer all your questions and concerns. The discogram may help give useful information about your pain and assist your physician in planning your treatment.