Discography

Why it’s done:

An initial discogram is not typically conducted for back pain because it is an invasive test. When conservative measures, such as medication and physical therapy, are ineffective, your doctor may suggest a discogram.

Doctors use discograms to determine which disks should be removed prior to spinal fusion surgery. Although discograms are often accurate in identifying the disk or disks causing back pain, they are not always 100% accurate. In some cases, doctors use other tests to diagnose and treat disc problems, such as MRI and CT scans.

What are the benefits vs. risks?

Benefits:

• This test determines if your back pain symptoms are caused by a specific intervertebral disc.
• An x-ray exam does not leave any radiation in your body.
• The normal diagnostic range of this test is usually devoid of side effects associated with X-rays.
• This noninvasive and painless process is fast, simple, and accurate.
• In addition to displaying bone, soft tissue, and blood vessels simultaneously, CT also provides excellent images of bone.
• A CT scan offers very precise images of many different types of tissue, including the lungs, bones and blood vessels, unlike conventional x-rays.

Risks

• The risk of infection occurs whenever the skin is penetrated. One in 1,000 chances of contracting an infection that requires antibiotic treatment appear to be extremely low.
• Injections of contrast material may cause a slight side effect of allergic reactions.
• Radiation exposure can cause cancer, but it is very unlikely. Medical imaging, however, utilizes very little radiation, so the benefit of correct diagnosis is far greater than any associated risk.
• Whenever a woman is pregnant, she should tell her x-ray technician and doctor. For more information on x-rays and pregnancy, please visit our pages on X-Rays, Interventional Radiology, and Nuclear Medicine.
• In this procedure, there is a variable radiation dose. More information about radiation dose can be found on the Radiation Dose in X-Ray and CT Exams page.
• Because of potential risks to the unborn child, pregnant women are not typically recommended to undergo CT scanning unless medically necessary.
• Breastfeeding should not be resumed within 24 hours after contrast material injection.
• Contrast materials containing iodine are extremely unlikely to cause serious allergic reactions. Allergy management is well-developed in radiology departments.

In general, discograms are considered safe. However, there are some risks involved:

• temporary numbness or weakness
• nerve damage
• paralysis
• injury to blood vessels or nerves in and around the spine
• bleeding
• temporary worsening of chronic back pain
• headache
• nausea
• infection of the injected discs

How you prepare:

If you plan to undergo the procedure, you will need to refrain from taking blood-thinning medications. A physician can recommend which medications are safe. Before the procedure, it is not recommended that you eat or drink anything.

What you can expect:

• Dye injection into a spinal disk
• Diagnosing the appearance of normal and damaged spinal disks using dye injections Open pop-up dialog box.
• Discogram images Open pop-up dialog box
• Clinics and hospitals with imaging equipment perform discograms. You may have to wait anywhere from three hours to three and a half hours while the test itself takes approximately 30 to 60 minutes.

Before the procedure

A sedative through a vein may help you relax during the procedure, even though you’re awake. If necessary, an antibiotic may also be administered to keep you from becoming infected.

During the procedure:

An abdominal or side table is laid out for you. In order to decrease discomfort caused by the needle insertion, your doctor may inject you with numbing medicine after cleansing your skin.

To monitor the discogram needle’s entry into your body, a diagnostic imaging technique (fluoroscopy) is used. An examination of the disk can be performed more precisely and safely using fluoroscopy. Following the injection of the contrast dye, an X-ray or CT scan is performed to determine whether the dye spreads.

Normal disks remain dye-free if the dye stays in the middle. In this case, wear-and-tear damage occurred to the disk. Your pain might be associated with these changes.

In most cases, if you suffer from back pain due to a disk, you will feel similar pain during the injection as you do on a daily basis. In an unaltered disk, the injection is not painful. A discogram includes an opportunity for you to describe and rate your pain.

After the procedure

Observation will take about 30 minutes to 60 minutes in the procedure room. Afterward, you can drive yourself home, but someone has to drive you.

It’s natural to experience some pain after the procedure at the injection site or in the low back for a few hours. An ice pack applied continuously for 20 minutes may help. Your back should be kept dry for 24 hours afterward.

You should contact your physician as soon as possible if you develop severe back pain or a fever within one to two weeks of the procedure.

Potential Complications: (rare)

• paralysis
• Nerve damage
• Bleeding
• Hoarseness of voice
• Temporary numbness or weakness
• Infection
• Spinal headache

Results:

If your doctor determines the cause of your back pain based on the photos and information you provided about your pain during the procedure, he will do so after reviewing the images and information you provided. As your doctor prepares you for surgery or for treatment, he or she will use this information.

The results of a discogram alone are rarely sufficient to diagnose a problem as a worn-out disk may not cause pain. Additionally, discograms can present a wide range of pain responses.