DiscographyWhat is a disc? The intervertebral discs
make up one-fourth of the spinal columns length. The intervertebral
discs are fibrocartilengous cushions serving as the spines shock
absorbing system, which protect the vertebra and other structures. The
discs allow some vertebral motion but it is limited to bending
forwards and backwards. There is not much movement between each
disc.
Intervertebral discs are made up of annulus fibrosis and a nucleus pulposus. Annulus fibrosis is a strong radial tire – like structure made up of concentric sheets of collagen fibers connected to the vertebral end plates. Disc receives its nerve supply from the spinal nerves. What is a discogram? A discogram is a diagnostic test performed to view and assess the internal structure of the disc and determine if it is a source of pain. Discography is performed
as additional testing to assign a “pain generator” status to
the individual disc. Discography is accepted as the disc evaluation
procedure of choice in many circles. Discography investigates,
and establishes the intervertebral discs role in the production
of patients pain.
Who is a candidate and when is discography indicated?
Discography should not be
performed as a first choice procedure unless conservative treatment
including injections performed under the x-ray failed to provide
good relief.
How is discography performed? Discography is an outpatient
procedure performed under x-ray guidance. A patient is taken
into the holding area where intravenous placement is performed. Subsequently
the patient is positioned in the operating room on the operating
table on their stomach in such a way that a physician can best
visualize the discs in the back using x-ray guidance.
Appropriate preparation is carried out under extreme sterile conditions. Following this the skin is infiltrated with a small dose of local anesthetic or numbing medication. After the numbing medicine takes effect two needles are used, one outside needle and one inside needle to approach the disc using the x-ray guidance. A small amount of contrast (dye) is injected to ensure proper needle position inside the disc. Then a small mixture of numbing medicine (anesthetic) and antibiotic are injected. A discogram will show if exact pain is reproducible when the disc is stimulated. A discogram may also show annular tears, disc bulging, leaking of the disc, etc. Discogram is not a procedure for treatment even though occasionally a patient may respond.
What happens after the procedures? The patient is closely monitored for any potential complications or side effects. Following the monitoring of 20-30 minutes patient is discharged. Patient returns for follow-up visit to discuss the findings of the discogram with regards to how to proceed with further treatment. Post-procedure Instructions You were given a number of medications during the procedure. These sometimes include sedatives, narcotics, local anesthetics, steroids, and other medications. Any of these drugs or procedure itself, sometimes can cause side effects, including drowsiness, temporary numbness, weakness and soreness.
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