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Discography and why is it helpful?

Discography is a diagnostic procedure, it is not meant to provide pain relief. This procedure is utilized to help your physician determine whether or not your pain is coming from one or more discs in your spine. Discography is performed with the use of a fluoroscope (special x-ray machine) to guide the placement of the catheters. Dye is injected into each disc, and the disc pressure is measured. A normal disc creates a pressure sensation when it is injected. Dye that is injected into a disc that has internal tears and is inflamed will reproduce your usual back or neck pain.

Discography is reserved for patients who have not responded to medications and conservative treatments, such as physical therapy and procedural interventions.

The discs in your spine act as a shock absorber similar to radial tires. They absorb the pressure placed on your vertebrae when you bend or twist your spine or lift something. This daily wear and tear of the discs cause them to degenerate. Disc degeneration is not necessarily painful, but the degeneration that occurs weakens the disc, making it vulnerable to injury. Degenerative changes can involve bone spurs, flattening of the disc due to loss of disc fluid, and weakening of the disc wall. If too much pressure is placed on the spine a degenerated disc can bulge or herniate. It may even tear open or disrupt. When a disc bulges and presses against nerves it causes pain. If a disc tears open it allows fluid from the center of the disc to leak out into the epidural space and often onto the nerves that are close to the disc. This disc fluid leak is very inflammatory when it is outside the disc center. It irritates anything it contacts, such as the epidural space or spinal nerves. This is the reason disc tears can be painful. Discography is being done to confirm which disc or discs might have torn and are causing your pain.

How should I prepare for the test?

1. Make arrangements to have someone accompany you to the office and drive you home after the procedure.

2. Unless otherwise directed by someone from our office, do not eat any solid foods or drink anything after midnight on the night before the test.

3. If your medical doctor prescribes any heart medication then you may take these medications with a sip of water the morning of the procedure.

4. It is important to take your regular heart medications according to your usual schedule to avoid any heart or blood pressure problems during the procedure.

5. If you are a diabetic please let us know so we can schedule you as one of the first cases in the morning.

6. Discuss how to adjust your diabetic medications with your medical doctor. He or she may hold your diabetic medications the night before the procedure and adjustments may be made for the first 3 days after the procedure.

7. Come dressed comfortably in a warm-up suit, sweats or shorts.

8. Be prepared to be in our office approximately 4 hours. This time includes registration, admission to the procedure suite, preparation for the procedure, the procedure itself and the post discography CT Scan.

What will happen to me during the procedure?

1. Before the test, you will be asked to change into a hospital gown and an intravenous (IV) line will be placed in your arm.

2. The nurse will discuss the test with you, explain the risks, answer any questions, and have you sign consent forms.

3. You will receive IV sedation during the procedure to keep you comfortable, however, you will be alert enough to describe what you are feeling as the discs are injected.

4. It is important to focus on the symptoms you feel with each disc injection.

5. You should be determining whether or not the pain that is provoked is like your usual back or neck pain.

6. Using the fluoroscope, your physician will place a needle into the center of each disc individually.

7. When the needle is in place he will begin to measure the pressure within the disc and continue to measure the pressure as he injects a small amount of dye slowly into the disc.

8. He will be asking you how you feel, if you are experiencing any pain and if the pain you feel is like your usual back or leg pain.

9. If pain is provoked it usually lasts less than a minute.

10. A disc that is normal or not torn does not cause pain when the dye is injected.

11. If a disc is torn the injected dye forces the disc fluid out which will reproduce your back, maybe even your leg pain.

12. If you do experience pain you will be asked to rate it on the scale of 10 we use in the office.

13. Usually, only 3 discs are injected.

14. However, if you have 3 discs, which are torn and painful, then a fourth disc may be injected so that you and the physician can compare torn or abnormal discs to a normal disc. This procedure may take up to an hour to perform.

15. Once the procedure has been completed you will be sent for a CT Scan, which will provide imaging of your discs.

16. You may go home after the CT Scan has been completed.

17. Sitting with your seat reclined at a 30-45 degree angle may cause less discomfort as you ride home.

What should I expect after the procedure?

1. Remember you should not drive for 24 hours after receiving IV sedation.

2. Please make the necessary arrangements for a driver to accompany you.

3. You may experience an increase in your symptoms for several hours, possibly 3 days.

4. You should avoid strenuous activity such as heavy lifting, yard work, and housework for the first 3 days after the discogram.

5. Light activities, but not bed rest, are recommended for 24 hours after the procedure.

6. Generally, patients have mild soreness at the injection sites, and it may increase your back and leg pain temporarily.

7. If necessary, pain medication may be prescribed for 3-5 days after the discogram.

8. We will see you within one week after your discography to discuss the discography results and treatment options with you.

What should I do after the procedure?

1. You should avoid strenuous activity such as heavy lifting, yard work, and housework for the first 3 days after the discogram.

2. Light activities, but not bed rest, are recommended for 24 hours after the procedure.

3. After 24 hours you may resume your usual activities.

4. The application of ice generally relieves post-procedure pain better than heat.

5. Do not sit in water or swim for 3 days after the procedure.

6. This is a precaution against introducing any bacteria into the injection sites.

What are the risks?

1. Although discography is a minimally invasive procedure, complications are possible but are infrequent.

2. The most important complication is an infection of the disk, occurring in 0.1 to 0.2% of patients.

3. Other possible complications are needle breakage, accidental intradural injection, intrathecal hemorrhage, meningitis, arachnoiditis, osteomyelitis, epidural abscess, spinal headaches, or allergic reactions to the x-ray dye or other medications.

4. With strict asepsis and a meticulous technique, these complications can be prevented.

5. Incidence of infection can be decreased with use of prophylactic antibiotics, stiletted needles, and the double needle technique, which is used at SPS.

Can I go to work to work the next day?

1. You may want to take the following day off from work, however if you have a sedentary job and you feel like it you may return to work the day after the discogram.

2. People who have heavier job demands will be given an excuse from work if needed for 24-48 hours after the discogram.