Aathi Thiyaga, M.D - HARVARD Fellowship trained spine & pain management specialist caring for greater Greenville patients since 2002.

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Fig: X-ray picture after discogram

What is a discogram?

A discogram is a radiological procedure where x-ray dye (contrast agent) is injected into the disc  between two vertebrae of the spine. At the same time as the injection, the physician performing the study records any verbal comments the patient provides at the time of the injection. If concordant pain is elicited by the injected dye, a positive test is recorded. The positive test indicates presence of potential pain generator inside the disc. Discogram may be followed with CT scan of the spine to understand further characteristics of the disordered disc. 


What will the x-rays reveal?

A normal disc consists of a central jelly - like material called the nucleus pulposis. This is surrounded by a thicker fibro cartilaginous ring called the anulus fibrosis. The normal disc acts like a cushion between two vertebrae of the spine. When a disc gets injured or undergoes abnormal aging, tiny cracks occur in the outer annulus. These are called anular fissures or tears and may be a cause of pain. When these fissures enlarge, some of the central jelly material may squeeze through these cracks and protrude outside the normal disc causing some pressure on the adjacent  nerve roots, thereby resulting in pain. These disc protrusions are referred to as herniations. In more advance cases of "disc aging", the entire disc degenerates, and there is no longer any distinction between the nucleus and annulus. The radiologist will be able to identify what is wrong with the injected disc space and will comment on that in the report.


Will the procedure hurt?

One of the main purposes of the discogram is to try to find out where your pain may be originating from in the spine. Therefore, if a disc that is known to be abnormal by either an MRI, myelogram, or prior CT scan is injected, you may experience some degree of discomfort or pain, ranging from mild to severe in intensity. Of course, this can be soothed almost immediately afterwards by directly injecting some numbing medicine (lidocaine or xylocaine) directly into the disc space. As the numbing medicine wears off within several hours, you may re-experience some discomfort. You can always take some form of pain medication afterwards for relief. Again, keep in mind the main directive in performing the study - trying to evaluate the source of pain such that your physician knows its location. Only by knowing where your pain originates from can the physician then come up with an appropriate plan for treatment.


Are all injected discs painful?

No. Normal discs may only cause a minimal degree of pressure or produce no symptoms at all. Abnormal discs that have annular tears, herniations, or degenerated discs may reproduce your discomfort or induce a different pain response that you are not familiar with.  


Are the side effects the same as the myelogram?

No. Since the spinal canal is not punctured, the two exams are very different. The needle used in discography is inserted only into the disc cushion between any two vertebrae. No fluid is collected as is during the myelogram. There is no cause for the development of headaches or any other potential side effects that may be associated with the myelogram.


Are there any complications with the discogram procedure?

As with any invasive procedure when a needle is introduced into the body, there is always the chance for introducing infection. One may develop a soft tissue infection or even a disc space infection. Of course, the likelihood of this is quite small. However, if this were to occur, you may develop symptoms typical of any infection - increasing pain and fever. You might then be treated as with any other infection and may be given antibiotics. Very rarely, if a disc space infection were to occur, you may even require surgery to drain any possible abscess that might form. In the rare event of a disc space infection, this would typically occur within the first several weeks following the procedure. Of course, steps are taken to minimize the chance of this ever happening. The radiologist who is performing the study is dressed in sterile surgical attire, and the area to be examined is initially thoroughly cleansed with antiseptic solution, whereupon, a sterile surgical drape is applied over the region. Another potential complication is bleeding, although this is usually minimal and is of no concern unless you are taking blood thinners or anticoagulants at the time of the exam. You should always inform the radiologist if there is a question as to any medication you are currently on.


Will I be able to leave immediately afterwards, or is there an observation period like the myelogram.

Immediately following the discogram, most patients undergo a CT scan of the injected disc levels. This requires that you simply lie on the CT table and additional pictures are taken without any further injections. This provides further information regarding the anatomy of the disc space. The CT scan usually takes between 5 - 10 minutes and then you are free to go home.

Are there any further restrictions or precautions to take after going home?

No. Once you are through, there are no precautions that you must follow. Of course, you may still have some lingering discomfort, which you may treat with pain medications.


What if I have an allergy?

You should always alert your physician if you are an allergic individual. If you do have a true allergy to the numbing medicine used, usually lidocaine or xylocaine, or even to iodine (used in most radiographic contrast fluids), your physician should decide if it is still necessary to undergo the procedure. If they feel that it is still warranted, you can be pre-medicated with a short dose of steroids for 1-2 days and then undergo the procedure in a more controlled environment. If there are specific questions, please ask the radiologist on duty.


Should I take my normal medications on the day of the exam?

Yes, you should continue with your normal medications. However, you should stop taking aspirin or any other blood thinners (anticoagulants) well ahead of your scheduled appointment if it is safe to do so. Usually, this means stopping aspirin approximately 5 days prior to your exam. Please notify the radiologist if you are on any such anticoagulants at the time of making your appointment in order to avoid any unnecessary delays.


Should I eat a normal breakfast the morning of the exam?

There are no specific dietary restrictions on the day of the exam. A light breakfast or recent meal should not interfere with the exam.


May I drive myself home after the study?

Although, there are no physical restrictions following the discogram, in contrast to the myelogram, it is still not advisable to drive yourself home, since you may still have some discomfort and may not be fully able to safely drive a car.


When will the exam results be ready?

Usually, the results will be ready by the end of the same day of your exam. Your doctor will then get the films and typed up report, so they may go over the results with you at your next appointment.


Is this procedure covered by insurance?
The overwhelming majority of insurance companies currently cover this procedure including Medicare and other government insurance plans. However, your coverage may vary depending on your specific plan and policy.


Which studies support the use of discography?
There are numerous studies supporting the use of discography in the diagnosis of spinal pain. Discography is considered a standard accepted procedure in the fields of pain medicine, radiology, orthopedic spine surgery, and neurosurgery. The following is a list of studies supporting discography.


  •  Manchikanti et al. Provocative Discography in Low Back Pain Patients With or Without Somatization Disorde: A Randomized Prospective Evaluation. Pain Physician, Volume 4, No. 3, 2001, pp. 227 -- 239.
    This study evaluated 50 randomly assigned patients with 25 patients without somatization disorder and 25 patients with somatization disorder. All patients underwent lumbar discography. Results showed positive provocative discography in 46% of the patient in the somatic sensation group compared to 54% in the non somatic station group. It is concluded that provocative discography provides similar results in patients with or without somatization disorder.


  • Southern EP. Disc degeneration: A Human Cadaveric Study Correlating Magnetic Resonance Imaging And Quantitative Discomanometry. Spine 2000 September 1; 25 (17): 2171 -- 2175.
    This was a human catheter study evaluating disc degeneration of the lumbar spine using MRI and discography with manometry. Based on results from 19 discs, an overall good correlation between MRI scores and 6 discomanometric parameters were demonstrated. Quantitative discography with manometry may be an important technique for evaluating early disc degeneration especially tears of annular fibers which may be missed on MRI.


  • Ohnmeiss et al. Relation Between Pain Location and Disc Pathology: A Study of Pain Drawings and CT/Discography. The Clinical Journal Pain, volume 15, 1999, pp. 210 -- 217.
    This is a study of 187 patients with lower back pain and lower leg pain that underwent CT/discography at the lower three lumbar levels. Results showed a statistically significant relationship (p < 0.05, chi-square) between pain location in the drawing and lumbar disc levels identified as clinically painful and disrupted by CT/Discography. The results of this study indicate that pain drawings may be helpful in identifying specific discs associated with pain complaints.


  • Min, K. et al. Discography with Manometry and Discographic CT: Their Value in Patient Selection for Percutaneous Lumbar Nucleotomy. Bulletin of Hospital Jt Dis. 1996; 54 (3): 153 -- 157.
    This was a study that analyzed the findings of 360 lumbar discs from 1988 -- 1994. The diagnostic accuracy of determining the exact anatomic location of the herniation with discography alone was 75%. This increased to 99.55% with the use of CT discography. The conclusion is that CT discography is an accurate and useful diagnostic aid.


  •  Derby et al. The Ability of Pressure Controlled Discography to Predict Surgical and Nonsurgical Outcomes. Spine 1999 February 15; 24 (4): 364 -- 71.
    This was a multicenter retrospective study of long-term surgical and nonsurgical patient outcomes after lumbar discography. Patients with highly sensitive or chemically sensitive discs appear to achieve better long-term outcomes with interbody/combined fusion than with intertransverse fusion. Precise prospective categorization of positive discographic diagnoses may predict outcomes for treatment.


  •  Walsh et al. Lumbar Discography in Normal Subjects. A Controlled, Prospective Study. Journal of Bone & Joint Surgery American. 1990 August; 72 (7):1081 --1088.
    This was a study of 7 patients with lower back pain and 10 normal volunteer patients. There were 5 raters blinded to the condition of the participant that graded the disc as normal or abnormal on the basis of magnetic resonance images made before the injection and CT/discography. Each participant's pain related response was evaluated independently by two raters who viewed the videotapes of the discography. Inter-rater reliability for pain was 0.99. In asymptomatic individuals, the discogram was interpreted as abnormal for 17% of the 35 discs.


  •  Schwarzer et al. The Prevalence and Clinical Features of Internal Disc Disruption in Patients with Chronic Low Back Pain. Spine 1995 volume 20, No. 17 pp. 1878 -- 1883.
    This was a cross-sectional analytic study of patients with chronic lower back pain. There were 92 consecutive patients with chronic low back pain and no history of previous lumbar spine surgery. The diagnostic criteria for internal disc disruption were fully satisfied in 39% of the patients most commonly at L5 S1 and L4 5.


  •  Botsford et al. Radiological Considerations: Patient Selection for Percutaneous Laserdisc Decompression. Journal of Clinical Laser Medicine Surgery 1994 October; 12 (5): 255 -- 9.
    This was a retrospective study of 90 patients treated with percutaneous lumbar disc decompression. There was overall improvement in 73.3% of treated patients. An abnormal CT discogram correlated with success in 100% of the treated patients whereas abnormal MRI, CT scan alone, myelogram correlated with 75% success. Therefore this study suggests that discography can greater predict surgical success.




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Last modified: November 11, 2012anderson clemson piedmont pain  management palmetto carolina comprehensive st francis memorial hospital spine neck back fibromyalgia Easley Liberty Pickens Upstate Anmed