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1. What is a disc?
2. What is a discogram?
3. Who is a candidate and when is discography indicated?
4. How is discography performed?
5. What happens after the procedure?
6. What are the expected results?
7. Post-procedure instructions

What is a disc?

The intervertebral discs make up one-fourth of the spinal column's length. The intervertebral discs are fibrocartilengous cushions serving as the spine's shock absorbing system, which protect the vertebra and other structures. The discs allow some vertebral motion, but it is limited to bending forwards and backwards. There is not much movement between each disc.

Intervertebral discs are made up of annulus fibrosis and a nucleus pulposus.

Annulus fibrosis is a strong radial tire-like structure made up of concentric sheets of collagen fibers connected to the vertebral end plates.

The disc receives its nerve supply from the spinal nerves.

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What is a discogram?

A discogram is a diagnostic test performed to view and assess the internal structure of the disc and determine if it is the source of pain.

Discography is performed as additional testing to assign a "pain generator" status to the individual disc(s). Discography investigates and establishes the intervertebral disc's role in the production of the patient's pain.

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Who is a candidate and when is discography indicated?

The indications for discogram include:

· A patient who experiences persistent spinal pain
· When a disc abnormality is suspected
· When non-invasive tests have failed to provide an explanation or source of pain
· When a pain correlation is desired
· A patient who is willing to undergo treatment directed at the disc

Discography should not be performed as a first choice procedure unless conservative treatment, including injections performed under x-ray, failed to provide good relief.

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How is discography performed?

Discography is an outpatient procedure performed under x-ray guidance. The patient is taken into the holding area where intravenous placement is performed. Subsequently, the patient is positioned in the procedure room on the operating table on their stomach. Minimal sedation and an intravenous antibiotic are given to the patient for post-operative infection profilaxis.

Appropriate preparation is carried out under extreme sterile conditions.

Following this, the skin is infiltrated with a small dose of local anesthetic or numbing medication. After the numbing medicine takes effect, a needle is advanced under fluoroscopic (x-ray) guidance inside the disc. A small amount of contrast (dye) is injected to ensure proper needle position inside the disc. At the end, before the needle is removed, a small mixture of numbing medicine (anesthetic) and antibiotic are injected.

A discogram will show if exact pain is reproducible when the disc is stimulated. A discogram may also show annular tears, disc bulging, leaking of the disc, etc.

A CT scan is usually performed on the painful disc(s) after the dye is injected to obtain images of the dye distribution. This will demonstrate anular tears, disc bulges and changes of the nucleus of the disc.

A discogram is not a procedure for treatment even though occasionally a patient may respond.

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What happens after the procedure?

The patient is closely monitored for any potential complications or side effects. Following the monitoring of 20-30 minutes, the patient is discharged and goes to have the CT scan done at a nearby hospital.

The patient will return for a follow-up visit to discuss the findings of the discogram with regards to how to proceed with further treatment.

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What are the expected results?

· Reproduction of painful symptoms if the disc/discs is/are abnormal.
· Confirmation of a diagnosis and/or determination of which disc/discs is/are the source of pain.

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Post-procedure instructions

You were given a number of medications during the procedure. These sometimes include sedatives, narcotics, local anesthetics, steroids and other medications. Any of these drugs or the procedure itself sometimes can cause side effects, including drowsiness, temporary numbness, weakness and soreness.

What to do after the procedure? Rest a few hours and use assistance if needed. Resume activity as tolerated, but do not overdo it. Resume your regular diet.

Restrictions: Do not drive or operate machinery for at least 12 hours. Do not make important decisions for 12-24 hours after treatment. Walk with assistance as long as numbness, weakness or drowsiness is present.

Notify the office if you have: Excessive or abnormal bleeding, persistent chills or fever over 100 degrees or if there is no major change in pain pattern or level.

Emergency: In case of emergency, call (954) 493-5048. If you are unable to reach the physician, report to the nearest emergency room and request them to inform the physician at Fort Lauderdale Pain Medicine.

Few other things: Resume your usual medication(s). Apply ice as instructed. If the IV site becomes painful, place warm towels on the site for 20 minutes, 2-3 times a day.

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