OKC’s Pain Clinic

What is a discogram?

A discogram is a diagnostic procedure in which x-ray dye or contrast material is injected into the discs of the spine. After the x-ray dye is injected, an x-ray, called a discogram, is taken of the discs. The discogram may be normal or may show tears, fissures or other damage to the disc. The results of a discogram are used to plan treatment of the disc itself.

What is the purpose of a discogram?

A discogram is typically done to answer the questions two questions. “Is my back pain or neck pain directly caused by a degenerated or damaged disc?” and “Which discs are causing my pain?” A discogram will not treat a damaged disc; it is a test, not a treatment. Treatment will be determined by the findings of the discogram.

How do I know if my pain is from a damaged disc?

With age or injury, the wall of the spinal discs can get cracks, tears or fissures. This condition is called internal disc disruption or degenerative disc disease. Also, the wall of the disc can weaken and bulge out, occasionally enough to cause a herniated disc. When the disc itself causes pain, the pain is usually felt as a deep, aching pain in the neck or back. Neck discs may sometimes cause pain into the arms and upper back. Back discs may sometimes cause pain into the buttocks and into the thighs. However, pain from other structures in and around the spine may cause pain in the same locations and feel the same. Sometimes the best way, although not perfect way, to tell if the pain is directly from a damaged disc is with a discogram. This will give an effective pain treatment.

How is a discogram actually performed?

The procedure is performed with fluoroscopic x-ray guidance. The discogram is performed under sterile conditions and intravenous antibiotics are given before the procedure. Lumbar or thoracic discograms for discs in the back are done with the patient lying on the stomach. Cervical discograms for discs in the neck are usually done with the patient lying on the back. There will be monitoring during the procedure. You will receive some sedation to help you be comfortable and relaxed. The patient is monitored by a pain doctor with an EKG monitor, blood pressure cuff and an oxygen-monitoring device. The skin over the injection site or sites is cleaned with an antiseptic solution. Then the skin and superficial tissues are numbed with local anesthetic. Next, a needle is passed under x-ray guidance into the disc or discs to be studied. X-ray contrast dye and possibly other medications are injected into the disc with varying amounts of pressure. The physician will ask questions during the injection regarding your symptoms so you will need to be awake enough to answer. When completed, the needle or needles are removed and usually only Band-Aids are applied.

What will I feel during the discogram?

When a normal disc is injected, you will feel a sense of pressure, but not pain. When an abnormal disc is injected, you will feel pain. It is important to try to tell your pain management doctor if the pain you are feeling is your usual pain or different. With each disc injected, you will be asked if it is painful, where you feel the pain and whether it is in the same area as your usual pain.

How many discs will be injected?

Based on your symptoms, your examination and your MRI, we will identify which discs we suspect are causing your pain. These discs will be injected by a pain doctor. Rarely do we inject more than three or four disks at one visit. At times only one or two disks may be injected.

How long does a discogram take?

A discogram takes about twenty to thirty minutes per level injected, with the total time depending on how many levels are injected.

What is actually injected?

The injection consists of x-ray dye (x-ray contrast). It may be mixed with some antibiotics to prevent infection. Occasionally local anesthetic or steroid may be injected as well.

Will the discogram hurt?

The discogram involves inserting a needle through skin and deeper tissues, so there is some pain involved. However, your doctor will numb the skin and deeper tissues with a local anesthetic using a very thin needle before inserting the needle into the disc. Most of the patients also receive intravenous sedation to make the procedure easier to tolerate.

Will I be “put out” for the discogram?

No. This procedure is done under local anesthesia. Injection of a local anesthetic is used to numb the skin. Most of the patients also receive some sedation, to help them relax and make the procedure easier to tolerate. The amount of sedation given depends upon the patient. You can be sleepy while the needles are placed, but during the discogram injections, you need to be awake enough to tell the doctor what you are feeling. Some patients have enough sedation that they have amnesia and may nit remember all or parts of the actual procedure.

Will my pain be better after the discogram?

No. A discogram does not treat your condition. It is a diagnostic test that allows your physician to plan specific treatment for any actual disc problem diagnosed or confirmed by the procedure. You could have a flare-up of your back pain after the injection, but this gets better in a day or two and can usually be managed with ice packs and oral pain medication.

What should I do after the discogram?

All patients will need a ride home. We advise the patients to take it easy for a day or so after the procedure. You may need to apply ice to the affected area for ten minutes at a time every hour or so for the next day. Perform only the activities you can reasonably tolerate.

Can I go to work to work the next day?

Most patients are recommended to rest for 2-3 days after the injection.

What are the risks and side effects of a discogram?

Generally speaking, this procedure is safe. However, with any procedure there are risks, side effects and possibility of complications. The most common side effect is pain at the injection site, which is temporary. Sometimes, the discogram needle brushes past a nerve root and the nerve root is irritated. This pain usually gets better quickly. The other risks involve infection, bleeding and worsening of symptoms. Infection of a disc or discitis is a serious complication and must be treated with antibiotics. Fortunately, the serious side effects and complications are uncommon.

Who should not have a discogram?

If the patient is allergic to any of the medications to be injected, on a blood thinning medication, has an active infection going on, or has poorly controlled diabetes or heart disease, they should not have the procedure or at least consider postponing it if postponing would improve the overall medical condition of the patient. In general, most patients should not have a discogram without having tried simpler treatments such as rest, medication, physical therapy or other types of injections.

http://www.medcentral.org/body.cfm?id=344 July 25th, 2010