Cervical, Thoracic, Lumbar Discography

The discs are soft, cushion-like pads which separate the hard vertebral bones of the spine. A disc may be painful when it bulges, herniates, tears, or degenerates and may cause pain the neck, mid-back, low back and arms, chest wall, abdomen, or legs. Other structures in the spine may also cause similar pain such as the muscles, joints, and nerves. Before performing discography, it has usually been determined that these other structures are not the sole source of pain in a patient (through history and physical examination, review of x-rays, CTs, MRIs and/or diagnostic injection procedures such as facet injections, sacroiliac joint injections, and/or nerve root blocks).

What is discography and why is it helpful?

Discography confirms or denies the disc(s) as the source of pain. Utilizing x-ray guidance, this procedure involves the placement of a needle into the discs along with a contrast dye. CTs and MRI scans only demonstrate anatomy and cannot absolutely prove a patient's pain source. In many instances, the discs may be abnormal on MRI or CT scans but not a source of pain. Only discography can tell if the disc(s) themselves are a source of pain. Therefore, discography is done to identify painful disc(s) and help the surgeon plan the correct surgery or avoid surgery that may not be beneficial. Discography is usually done only if a patient's pain is significant enough for them to consider surgery.

What happens during the procedure?

An IV is started so that antibiotics (to prevent infection) and relaxation medications can be given. The patients are positioned on their backs for cervical discography and on their sides for both thoracic and lumbar discography. The skin on the back is scrubbed using 2 types of sterile scrub (soap). Next, the physician numbs a small area of skin with numbing medicine. This medicine stings for several seconds. After the numbing medicine has had time to take effect, the physician directs a small needle, using x-ray guidance, into the disc space. Patients generally feel temporary discomfort as the needle passes through the muscle or near a nerve root. The physician may perform this at more than one disc level. After the needles are in their proper locations, small amounts of contrast (dye) are injected into each disc.

What happens after the procedure?

Immediately after the disc(s) are injected, the patient is given a CT Scan where additional pictures are taken. Following the CT Scan, patients are returned to the recovery area where they are monitored for 30 - 60 minutes. Patients are usually given prescription medications for pain that they can take for a few days following the procedure. This helps with any muscle discomfort that may exist after this procedure.

General Pre/Post Instructions

Patients can eat a light meal within a few hours before the procedure. For patients who are insulin dependent diabetics, they must not change their normal eating patterns prior to the procedure. Patients may take their routine medications. (i.e. high blood pressure and diabetic medications). Patients should not take pain medications or anti-inflammatory medications the day of their procedure. Patients have to be hurting prior to this procedure. They may not take medications that may give pain relief or lessen their usual pain. These medicines can be restarted after the procedure if they are needed.