DISCOGRAMS

When other conservative treatments have failed and spinal surgery is being contemplated, a discogram which is a diagnostic procedure performed to determine which intervertebral disc(s) is the pain generator. The information provided by the discogram is extremely valuable to the spine surgeon to determine precisely where to operate in order to relieve pain. Unfortunately, imaging studies such as MRI cannot show pain, only anatomic abnormalities. Most abnormal appearing disks do not cause pain. Discography is a disk stimulation test design to reproduce pain so the “pain generating disk” can be identified and treated.

Before the procedure, blood thinners such as heparin, warfarin (coumadin), aspirin, and anti-inflammatory medications (except for celebrex) must be discontinued 5 days prior to the procedure date. If you are being treated by any specialist, medical clearance may be needed to proceed. The morning of the procedure, you may have something to eat or drink but nothing within 2 hours of the procedure.

At the surgical center an IV will be started by a nurse. When ready you will be taken to the surgical suite where you will be placed on your stomach for the procedure. This sterile procedure is performed under IV sedation. The area to be injected will be prepped and anesthetized with lidocaine (local anesthetic). Then under fluoroscopic (real time x-ray) guidance, small spinal needle(s) will be inserted into the discs to be tested. After the needles are in correct position the sedation is reversed. Once the patient is completely awake each disk is tested by injecting a small amount of contrast dye. A normal disk will generally produce no pain. The patients usual pain will be reproduced when the affected disk is stimulated. During testing, your pain response will be noted. Then pain producing disc(s) will be reinjected with lidocaine to both retest the disk and anesthetized the disk in order to reduce pain. After testing is complete, a selective nerve root block will be performed using the needle that is already in place to also help reduce pain. After the procedure is complete, the needles are removed. During the procedure your vital signs and oxygen saturation will be continuously monitored. After the injection, you will be taken to the recovery area and monitored until discharge criteria are met.

You will need a family member or friend drive you to another facility for CT scanning following the procedure. The CT scan is to further evaluate the internal anatomy of the disc. After the procedure, you may experience some temporary spasms near the injection site. If this occurs use ice or heat, whichever works best for you. If you are using ice, place a thin clothe barrier between your skin and the ice pack. Apply for 20 minutes to the affected area and you may reapply in 60 minutes if needed. If you are applying heat (moist or dry heat) refer to the manufacturer‘s instructions for application. Never sleep on a heating pad, burns may occur.

Complications are rare and include but not limited to bleeding, infection, damage to nerves and structures of the spine, spinal headaches, perforation of organs, collapsed lung, reaction to medications, increased pain, seizure, stroke, paralysis, damage to fetus if pregnant and death. You may be given antibiotics during the procedure. Your usual pain may be increased for a few days after the procedure. The risk of injection of steroids include thinning of bones, pathologic fractures, weakening of ligaments, damage to tissues, avascular necrosis of the hip, cataracts, decreased immunity, reaction to medication. Complications are rare. Side effects that occur commonly include flushing, fluid retention, rash, weight gain, insomnia, headache. Diabetics will have significant increased in blood sugars for a few days and will need to monitor their blood sugar levels closely and adjust medication as directed by their family physician. Sedation is used for patient comfort and to facilitate performance of the procedure. Complications of sedation are very rare and include aspiration, pneumonia, and loss of airway requiring emergency resuscitation or surgery. The risk of complications requiring transfusion is extremely low. The risks of transfusion of blood products include transfusion reaction, infection such as HIV or hepatitis and death.