DISCOGRAMS

 GENERAL INFORMATION 

            Pain in the neck or back  can develop following injury to the spine or as a result of aging, disc degeneration and arthritis.  Herniation of a disc or bone spurs can compress the spinal nerves in the neck or lower back and cause pain to radiate into your arms or legs. This may be associated with numbness or weakness. 

            Symptoms can often be improved simply by time, rest,  and common medications such as aspirin or Advil.   Exercises often under the supervision of a physical therapist may be started and hopefully allow you to return to full activity.    If however routine treatments are unsuccessful and your symptoms are intolerable your doctor may recommend further testing to obtain a clear picture of what is causing the pain and to assist in planning further treatment.

              Routine X-Rays studies are able to produce pictures of the bones of the spine and are often the first test  obtained.  They may be helpful but are limited because they are not  able to show the discs or spinal nerves.  If  more detailed information about the bones in a specific region is required a CT scan may be suggested.  Sometimes it is important to visualize all of the bones in your body.  If this is required a bone scan is indicated.  The special test most commonly used to image the nerves of the the spine is a MRI scan.  Often this is all that is required to understand the problem and plan treatment. Sometimes in more complex problems such as spinal stenosis and especially in people who have undergone previous surgery a myelogram combined with a CT scan is needed.  A discogram is a test sometimes used in patients with long standing back or neck pain to identify which disc is the cause of your pain and to help plan possible surgery.  

What is a Discogram?  

            A discogram is a test used to study the internal structure of the discs in your lower back and sometimes in your neck. In addition and  most importantly the test  can often identify the source of your pain.  A discogram requires that a needle be inserted into each of the discs to be studied.  Your doctor will determine the number discs that need to be studied. A contrast material is injected and a special X-Ray machine called a fluoroscope or C-Arm is used to image the disc and the contrast material inside of the disc.  The internal structure of the disc is visualized and small injuries of the disc can often be found.  The test is performed with you awake and this allows you to describe to the doctor any discomfort or pain that you experience during the injection.  In this way  you and your doctor are able to identify exactly which disc or discs  are the source of your pain.  The test is performed in the operating room. An anesthesiologist is present who can administer medication to help you to relax and feel more comfortable. 

THE PROCEDURE

            You should not have anything to eat or drink in the morning prior to the test because you will often be receiving intravenous sedation during the procedure.  When you arrive a nurse will greet you and answer any last minute questions.  In the procedure room you will be placed on a table either on your side with a padded cushion under your ribs or on your stomach if the discs in your lower spine are being studied.  If you are undergoing a cervical discogram you will be face up.  After your skin is cleaned with iodine and is numbed with local anesthesia the discogram needles are placed.  The fluoroscope machine is used to guide exact placement of the needles.  If you experience pain as the needles are inserted you can be given additional medication. When all of the needles are placed the discs are injected one at a time.  Your doctor will ask several questions after each disc is injected:

1.      Are you feeling any pain?

2.      How much pain on a scale of one to ten (1-10) ? 

3.      If you are having pain, where is it? Your neck/back? Your arm?  Your leg? 

4.      Is the pain similar to the pain you usually experience? 

When all of the discs are studied, the needles are removed and you will be monitored until stable.  After the sedative medication has worn off, discharge instructions are reviewed with you. A friend or relative must be with you or available to bring you home.  Driving is prohibited.

RISKS AND SIDE EFFECTS    

                         There are  a few potential risks and side effects  which you should understand.  Many  patients experience some increase in their typical pain following the procedure.  The discomfort which begins after the local anesthetic has worn off can last from several hours to a few days. It can be treated with rest in bed, an ice pack and/or Tylenol or Advil.  Your doctor may choose to give you a stronger pain medicine if appropriate. Allergic reaction to either the contrast agent ( iodine) or local anesthetic (xylocaine) is very rare.  If you think you may be allergic to either of  these medications you must notify you doctor. Complication from placement of the needle are rare. Infection in the disc can occur.  You will be given antibiotics prior to the procedure to minimize this risk.  Bleeding and nerve damage have been reported but are very rare.  

POST DISCOGRAM INSTRUCTIONS

 1. Rest at home for the remainder of the day following the injection.  Don’t tackle any big projects.  If you do experience aching in you neck or back try an ice pack for 15 - 20 minutes or some of your usual pain medication such as Tylenol, Advil or prescription pain medication if you have some.

2. The day after your injection if ready you may resume normal activities.  But remember not to push beyond your limits.

3. Contact your doctor or the emergency room  if you develop signs of infection (fever,  increasing back pain several days after the injection or redness at the site of injection), or if you notice a change in the way the nerves in your legs are working (increasing numbness or weakness) or a change in your bowel or bladder function.

4. Call your doctor’s office for a follow up appointment.