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The diagnostic discogram is a provocative test often used by spine specialists to determine whether the spinal disc is the likely cause of back or neck pain symptoms. Discograms are used in combination with clinical information obtained from bedside examination and imaging tests such as x-rays and MRI to gain a more accurate assessment of suspected painful discs. Discograms are used by some spine surgeons as a guide to spinal fusion, and more recently to guide minimally invasive treatments such as internal disc heating (also known as IDET), nucleoplasty, and laser disc decompression. The test relies most importantly upon the verbal report given by the patient when x-ray dye is injected under pressure into the disc. If the dye injection reproduces the “typical” pain experienced by the patient, the discogram test may support the conclusion that the disc is the source of pain. The appearance of the disc following the injection may also give additional details which may help to determine which therapy would be most appropriate for a given patient.
Discograms are safe and well-tolerated by most patients. The major risk of the procedure is infection, or “discitis” which is rare and usually treated with antibiotics, but may require surgery to eradicate. While the risk-benefit ratio of diagnostic discograms is very good, they are usually done only after less invasive tests and procedures have failed to provide a satisfactory diagnosis and/or treatment of the problem causing spinal pain. In many instances, pain specialists at Synergy Spine Center will recommend discograms prior to intradiscal treatments such as laser disc decompression or endoscopic spinal surgery.
What to expect:
The patient enters the preparation area where an I.V. line is inserted. Preoperative antibiotics are given to reduce the chance of infection from the procedure, and light sedation may also be given if desired. It is important not to over sedate the patient to allow an appropriate degree of verbal feedback of the response to disc injection. The patient is then taken to the procedure or operating room and placed face down on the procedure table with a pillow under the abdomen for lumbar procedures, or face up with a pillow under the head for cervical procedures. The x-ray camera is properly adjusted to see the disc clearly in multiple projections. The skin overlying the injection area is cleaned with antiseptic solution and draped with sterile towels. Local anesthetic is used to numb the skin, and the needle is placed into the center of the disc using x-ray guidance. Dye is slowly injected while the physician carefully notes the feel of the disc, the appearance of the images produced, and most importantly, the response of the patient. At the completion of the procedure, local anesthetic may also be injected into any painful discs to decrease the pain response which may have been caused by the discogram itself. All needles are removed, the patient is observed in the recovery room for a short while, and discharged home.