Discography is a minimally invasive diagnostic procedure that involves placing needles into the disc.

Generally, patients who undergo discography have not received satisfactory pain relief from non-operative measures such as medication, physical therapy and modified activities. They usually have had back pain for at least 4 to 6 months. Discography is usually used in patients who are being evaluated to determine a specific cause of pain so a new treatment plan (possibly including surgery) can be developed. It is important to realize that discography is controversial because it is not an exact science. As such, it is just one part of the puzzle your physician will use to craft a treatment plan specific to your needs.

You generally should not eat any solid foods after midnight before the discogram. A breakfast of clear liquids such as broth, clear juice, tea or gelatin may be allowed. You may want to wear comfortable clothing such as a warm-up suit, sweats, or shorts and a t-shirt to your discogram appointment. You should leave all valuables such as jewelry at home. It is a good idea to bring a book or something to help pass the time. The health care provider performing the procedure and/or a staff member will likely review the details of the procedure, as well as possible complications, with you. An informed consent form may be reviewed and any questions or concerns that you have can be addressed. You will probably be asked to complete a form and/or discuss with a medical staff member any history of allergic reaction to X-ray dye or xylocaine, allergies to medications, history of seizures or epsilepy and diabetes.

You may receive a light sedative to help you relax during the procedure, however, you will need to be awake and able to answer questions throughout the procedure.. Discography is usually performed in a procedure room that has equipment for X-ray imaging of the discs as the test is performed. You will be asked to lie on one side and may be rolled slightly forward on a table. Pillows can be used to help you achieve the desired position. Your skin will be wiped at the site of the injection with a cleansing antiseptic agent.

The suspected diseased discs and suspected healthy discs will be tested. This is to make sure that healthy discs test negative and that if a diseased disc tests positive, that the result is considered reliable. Typically, the lowest two or three lumbar disc levels are injected. The health care provider may inject an anesthetic into the skin to reduce the pain of the needles passing through tissue. Typically, antibiotics are given intravenously before and after the procedure.
A needle is inserted through the skin and muscle and comes to rest on the outer layer of the disc. During the process of placing the needles, imaging studies called fluoroscopy (similar to X-ray) are used to help the health care provider see where the needles are located along the path to the disc. A second needle is generally passed through the first one and into the center of the disc. This process is repeated at each level that is to be injected. In some cases, the health care provider may decide to inject an additional level and will place needles at that location after the initial injections. Contrast (a liquid that shows up on X-ray), is injected into the center of each disc. The volume and pressure of the injected liquid is monitored. If the disc is normal, the contrast remains in the center of the disc. If the disc is abnormal, the contrast spreads through the tears in the disc and may also leak out of the disc. As each disc is injected, you will be asked if you are experiencing pain. If there is pain, you will also be asked if the pain is similar to your usual symptoms in terms of location and the type of pain you are experiencing. You may be asked to rate the intensity of the pain that the injection causes, if any. This procedure is repeated for each disc that is injected. The pain provoked by the injection should be temporary.

The injection procedure generally takes about 30 minutes. After the disc injections, you may be kept for observation for 30 minutes or more. It is advisable that you have someone drive you home. In some cases, pain from the injection can persist for several hours. There may be some residual muscle pain from passing the needles. If you experience intense pain, call your health care provider.

The discography results are reviewed and given to your health care provider. Similar to MRI and all other diagnostic tests, discography is not perfect. Therefore it is important for your doctor to combine the results of the discogram with results from other tests and physical examination to better determine if the disc(s) is causing your pain. This information may be used to determine if surgery may be beneficial. If surgery is indicated, the results are used to determine the best type of surgery for you, and which disc levels may be included in surgery.

Discography is a diagnostic test and would not be expected to provide any symptomatic benefit. Your surgeon will go over the results of the study and discuss potential treatment options. This will add another piece of information to use to help set expectations for the results of any planned surgery so that you can make as informed a decision as possible.