into the spine with injection of contrast agent for the purposes of 1.
determining if there is a specific or more than one painful discs 2.
determining the presence of annular tears for further minimally invasive
spine procedures 3. determining whether a planned fusion surgery or
artificial disc replacement would potentially benefit the patient 4.
providing validation for the presence of pain generators in the spine.
Many people have annular tears which do not produce pain, therefore
discography is the only functional test of the tendency of a specific disc
to produce back and/or leg pain.
The sequence is as follows: sedation, placement of needles into the
center of the intervertebral discs, awakening, conversing, injecting the
disc with a controlled graded pressure with fluoroscopic evaluation and
with the patient giving feedback on the degree, character, and location of
pain produced in each disc, and subsequent CT scanning when
necessary. Discography can be performed at any level of the spine
including the thoracic and cervical spine, but the most commonly
injected discs are those of the lumbar spine. It is absolutely necessary to
have a control disc (one which does not produce significant pain at
reasonably high pressures) in order to have a valid discogram. Also, the
person's response to the injection (calm, clear answers vs.
unresponsiveness or refusal to answer questions) is as important as the
injection itself. Clearly, the pain reproduced during the injections is
more valuable an indicator of pathology which may be causing the
normal everyday pain than presence of annular tears on fluoroscopy. In
fact, if the pattern is grossly abnormal on fluoroscopic exam but the
patient has no pain, then the annular tear is probably not producing the
pain. Additionally, not only the presence of pain but the pressure at
which it is produced gives significant information regarding the degree
of disc pathology. Cervical discography has special considerations
which require two injections into the discs on different occasions. The
first is used to isolate the most painful discs and the second is to
anesthetize the inside of the suspected disc with a local anesthetic and
observe for post injection pain response over the ensuing several hours.
After the discogram, the patient may be taken to CT for further analysis
of the disc as seen in the last picture.
Side effects are usually pain for 1-7 days which may be somewhat
increased, a fullness in the spine, and muscle soreness. Complications
are uncommon but include in the lumbar area bleeding, infection, nerve
injury, infection of the disc, worsening pain, reaction to medications
used, anesthetic risks. In addition to the above, cervical discography
complications also include penetration of the esophagus, carotid artery,
jugular vein, or cord injury although all these are exceedingly rare.
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