© 2015 by Pain Management Centers of Paducah and Marion

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Pain Management Center of Paducah
67 Lakeview Dr, Paducah, KY | 270-554-8373

Paducah Ambulatory Surgery Center
2831 Lone Oak RD, Paducah, KY | 270-554-8373

Pain Management Center and
Pain Care Surgery of Marion
108 Airway Dr, Marion, IL | 618-997-7820

INTERVENTIONAL TECHNIQUES

 

 

Discography

 

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 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?

 

  • The indications for discogram include:

  • A patient who experiences persistent spinal pain

  • A disc abnormality is suspected

  • Non-invasive tests have failed to provide to an explanation or source of pain

  • A pain correlation is desired

  • Patient 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 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.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DISCOGRAM

DISCOGRAM

 

 

 

 

 

 

 

 

 

 

 

Modified Dallas scheme for annular tear classification.

 

 

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.

 

 

What To Do After the Procedure?

Rest for a few hours and use assistance if needed.Resume activity as tolerated, but do not overdo.Resume regular diet.

 

Restrictions:

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 is present.

 

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.

 

Emergency:

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 20 minutes2-3 times / day.