What 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
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?
- The indications for discogram
patient who experiences persistent spinal pain
disc abnormality is suspected
tests have failed to provide to an explanation or source
pain correlation is desired
is willing to undergo treatment directed at the disc
Discography should not be
performed as a first choice procedure unless conservative treatment
including injections performed under the x-ray failed to provide
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
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.
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,
Discogram is not a procedure
for treatment even though occasionally a patient may respond.
Dallas scheme for annular tear classification.
What happens after the
The patient is closely monitored
for any potential complications or side effects. Following the
monitoring of 20-30 minutes patient is discharged.
for follow-up visit to discuss the findings of the discogram
with regards to
how to proceed with further treatment.
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
|What To Do After the Procedure?
for a few hours and use assistance if needed.
Resume activity as tolerated, but do not overdo.
Resume regular diet.
Do not drive or operate
machinery for at least 12 hours.
Do not make important decisions for 12-24 hours after treatment.
Walk with assistance as long as numbness, weakness, or drowsiness
|Notify If You Have:
Excessive or abnormal
bleeding / persistent chills or fever over 100°F.
If there is a major change in pain pattern or level.
|| In case of emergency, call (270) 554-8373.
If unable to reach physician report to the nearest emergency room
and request them to inform physician at Pain Management Center.
|Few Other Things:
Take your usual medication.
Apply ice massage as instructed; may use heat if ice is intolerable.
If IV site becomes painful, place warm towels on the site for
2-3 times / day.