Also known as disc stimulation testing, discography is used to diagnose pain resulting from disc damage. If your neck or mid/lower back pain has not responded to other treatments, you may try a diagnostic discogram to determine if your pain is discogenic.
What is a Discogram?
Discograms determine which spinal discs are causing back or neck pain. Doctors can look into the internal structure of vertebrae and tell if there is something wrong that could cause pain, such as a tear. This is not a routine test and is often performed prior to surgery to determine the discs to be treated. Almost 80% of people will have back pain at some point, and it is the fifth-leading cause of doctor visits. Even the best MRIs do not have the diagnostic power of discograms.
Indications
Discography is helpful when a patient's chronic back or neck pain hasn't reacted to other treatments, and other diagnostic tests like MRIs have failed to find the issue. A discogram can be particularly helpful when the pain is caused by the disc itself. About 10% of back pain complaints can be attributed to discogenic pain.
| Stage | What happens |
|---|---|
| Purpose | A diagnostic test to find which disc is actually causing your pain |
| During | Contrast is placed in a disc under imaging; your response helps pinpoint the source |
| After | The results guide whether a targeted treatment or surgery makes sense |
What are the Benefits?
The thought behind discography relies on three things:
- High prevalence of spinal pain
- High prevalence of unusual MRI findings at asymptomatic levels
- Low success rate for surgery aiming to treat degenerative spondylosis
MRI is considered the best option for spine imaging, but it does not pair unusual findings with causes. MRIs can also be unreliable at diagnosing discogenic pain because they have shown abnormal spine curvatures in many patients with no pain at all. Discography is a better option in these cases.
Procedure — Patient Details
Discography is an outpatient procedure, during which you will be awake with mild sedation. You will take antibiotics to reduce infection risk. Your doctor will sterilize and anesthetize your back before using fluoroscopy to guide a small needle into the nucleus of the disc. Once the needle is properly placed, a contrast dye is injected so your doctor can see what shape it takes, revealing healthy or damaged discs.
You will be asked about your reactions to the dye. The discogram is positive if it can reproduce the same symptoms of back pain; otherwise, it is considered negative. Positive discograms mean that the source of your pain has likely been identified. This process is normally repeated in two other discs. You may also get a CT scan afterward to better visualize the contrast dye.
Your physician may restrict your food and drink before the test. Another person should take you home. The process is usually finished in an hour, although it may be longer if multiple discs are examined.
When Will I Be Better?
We usually ask patients to relax the day of the procedure and return to daily life the following day. You may experience discomfort for a couple of days after the procedure, and your doctor will tell you how to proceed. The results of your testing can play a big role in furthering your pain relief regimen.
Risk Factors
Any medical procedure involves risks. Discography has rare complications such as discitis, a painful infection in the disc. Other complications may include headache, numbness, increased pain, or bleeding/hematoma.