Discography (Lumbar)

What are the discs?
The discs are soft, cushion-like pads, which separate the hard vertebral bones of the spine. A disc may be painful when it bulges, herniates, tears or degenerates and may cause pain the neck, mid-back, low back and arms, chest wall, abdomen or legs. Other structures in the spine may also cause similar pain such as the muscles, joints and nerves. Before performing discography, it has usually been determined that these other structures are not the sole source of pain in a patient (through history and physical examination, review of x-rays, CT's/MRI's and/or diagnostic injection procedures such as facet injections, sacroiliac joint injections and/or nerve root blocks).

What is discography and why is it helpful?
Discography confirms or denies the disc(s) as a source of pain. This procedure involves the placement of a needle into the discs themselves, utilizing x-ray guidance and injecting contrast (dye). CT's and MRI scans only demonstrate anatomy and cannot absolutely prove a patient's pain source. In many instances, the discs may be abnormal on MRI or CT scans but not a source of pain. Only discography aids in telling if the disc(s) are a source of pain. Therefore, discography is done to identify painful disc(s) and help the surgeon plan the correct surgery or avoid surgery that may not be beneficial. Discography is usually done only if a patient's pain is significant enough for them to consider surgery. When multiple disc levels need to be assessed, the discography procedure will be scheduled as a series of 2-3 procedures on 2-3 different dates.

What happens during the procedure?
An IV is started so that antibiotics (to prevent infection) can be given prior to the procedure and other medication, if indicated, can be given during the procedure. The patients lie on their stomach on the xray table for discography. The skin on the back is cleansed with a sterile solution called Betadine. Next, the physician injects a small area of skin with numbing medicine. This medicine stings for several seconds. After the numbing medicine has been given time to be effective, the physician directs a small needle, using x-ray guidance into the disc(s) space. Patients generally feel temporary discomfort as the needle passes through the muscle or near a nerve root. After the needles are in their proper locations, small amount of contrast (dye) is injected into each disc.

IV (Intravenous) Conscious Sedation
Medication will be given during the procedure through the IV to make it easier for you to tolerate the procedure by helping you to relax and be less anxious. The medication will not "put you to sleep". You will be able to breathe on your own and respond verbally and physically. This type of medication does involve some potential risks: allergic reaction, slow breathing, low blood pressure, slurred speech, extreme drowsiness. Severe response could include stopped breathing or unarousable sleep.

What happens after the procedure?
After the disc(s) are injected, the patient is taken to the recovery area where they are monitored for a period of time. After the series of discography is completed a detailed report will be forwarded to the patient's physician.

General Pre/Post Instructions
Patients can eat a light meal before the procedure. If a patient is an insulin dependent diabetic, they should take their insulin and eat prior to the procedure. Patient may take their routine medications prior to the procedure (e.g. high blood pressure and oral diabetic medications). If a patient is on Coumadin, Lovenox, or Plavix (blood thinners) they should notify the office so that dosing may be individualized, if necessary, according to the patient's diagnosis. If you are allergic to iodine, contrast, or medical dye, please inform the office. Patients can expect to be at that facility approximately at least 3-31/2 hours. A driver must accompany the patient and be responsible for getting them home. It is best if no driving is done the day of the procedure and after the injection. Patients may return to their normal activities the day after the procedure, including returning to work unless instructed otherwise by their physician.