Discogram

A discogram is a diagnostic procedure in which x-ray dye is injected into the discs of the spine. After the dye is injected, an CT scan is taken of the discs. The discogram may be normal or may show tears in the lining of the disc. The results of the discogram are used to plan surgery or other treatment options.

WHAT IS THE PURPOSE OF A DISCOGRAM?

A discogram is done to determine which discs (if any) are the cause of your pain.

HOW DO I KNOW IF MY PAIN IS FROM A DAMAGED DISC?

With age or from an injury, the wall of the spinal discs can get cracks or tears (fissures). This condition is called Internal Disc Disruption of Degenerative Disc Disease. Also, the wall of the disc can weaken and bulge out (a herniated disc). When the disc causes pain, the pain is usually a deep, aching pain in the back and sometimes in the buttocks and in to the thigh. However, there are other causes of similar pain patterns that are not due to the disc. The best way to tell if the pain is from a damaged disc is with a discogram.

HOW IS A DISCOGRAM PERFORMED?

For a lumbar discogram (disc in the lower back), the patient will be lying on their stomach. For cervical (disc in the neck), it is usually done with the patient lying on their back. There will be a nurse present during the procedure to monitor you and administer intravenous sedation to help you be comfortable and relaxed. You are watched closely with an EKG monitor, blood pressure cuff and blood oxygen monitoring device. The area of the injection site is cleaned with an antiseptic solution and then the injections are carried out.

WHAT WILL I FEEL DURING THE PROCEDURE?

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 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. This will help identify which discs are damaged.

HOW MANY DISCS ARE INJECTED?

The number of discs injected is based on your symptoms and your MRI report. In addition, a normal disc is injected to serve as a reference point of control disc.

HOW LONG DOES A DISCOGRAM TAKE?

Approximately one hour, depending on the number of discs requiring injection. You should plan on being in the office for two to three hours to allow for pre-op and recovery. You will need to have a CT scan done afterward to confirm the findings. The arrangements for your CT scan will have been made prior to your visit so that you may go immediately following your procedure. You must not eat or drink anything until after your CT scan.

WHAT IS ACTUALLY INJECTED?

The injection consists of x-ray dye. It is usually mixed with some antibiotics to prevent infection.

WILL I BE “PUT OUT” FOR THE PROCEDURE?

No, this procedure is done under local anesthesia. You will receive intravenous sedation and analgesia to help you relax, and will also be receiving antibiotics through your IV. The amount of sedation given depends upon the patient. You can be sleepy during the placement of the needles, but during the actual discogram, you need to be awake enough to tell the doctor what you are feeling.

WILL MY PAIN BE BETTER AFTER THE PROCEDURE?

No, a discogram does not treat your condition. It is a diagnostic test that allows your doctor to plan your therapy.

WHAT SHOULD I DO AFTER THE PROCEDURE?

You will need a driver to take you to your CT scan and then home. You will need to take it easy for two to three days after the injection, and then resume normal activities. You will want to take two to three days off from work after this procedure.

WHAT ARE THE RISKS AND SIDE EFFECTS OF A DISCOGRAM?

The most common side effect is pain, which is temporary. Sometimes, the discogram needle brushes past a nerve and the nerve root is irritated. The pain almost always gets better quickly. The other risks involve infection, bleeding, and worsening of symptoms. Fortunately, serious side effects and complications are uncommon.

WHO SHOULD NOT HAVE THE PROCEDURE?

If you are allergic to any of the medications being injected, if you are on a blood thinning medication (Coumadin, Plavix or Aspirin), or if you have an active infection going on, are pregnant or think you may be pregnant, you should not have the procedure done. You should not have a discogram if you have not tried simpler treatments such as activity restriction and anti-inflammatory medications.

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