At Advanced Pain Consultants, we do our best to relieve back pain with minimally-invasive procedures. However, for some patients, surgery must be considered. Discography (or “disc stimulation”) is an outpatient imaging procedure that is done to determine which intervertebral discs (the cushions between the vertebrae in the spine) are causing pain and to what extent. Knowing this can aid in the development of an effective treatment plan, and help Dr. Pasi determine whether surgery is warranted.
During discography, Dr. Pasi uses a fluoroscope (a special x-ray machine that shows continuous imaging on a monitor) to locate suspected pain-generating discs. A dye is then injected into these discs, which puts pressure on the soft centers of the discs and induces pain for testing purposes. As each disc is injected with dye, the patient is asked to rate the severity of pain or pressure, usually on a scale of zero to 10. This information can help Dr. Pasi diagnose the source of pain.
Discography can provide additional information as well. After the injection of the dye, an x-ray photo is taken of the discs. This image, called a “discogram” may be “normal,” or it may show the presence of tears (fissures) in the lining of the disc, bulges, or other abnormalities. In general, if the x-ray imagining shows that the dye has remained in the center of the disc, this indicates that the disc is normal. On the other hand, if the dye has leaked out into the cracks and has spread outside the center of the disc, this may indicate that the disc has undergone some structural damage, which could be the cause of the pain. This information can help Dr. Pasi fine-tune her treatment plan.
Testing with discography is generally reserved for patients who have persistent or disabling lower back, groin, hip, neck, arm or leg pain, despite undergoing more conservative treatments such as medication, injection therapy, and physical therapy. The patient’s pain is usually so severe that a more invasive treatment, such as spinal surgery, is being considered.
A discogram is not normally used for an initial evaluation of back pain, as it is a more invasive than a lot of other types of diagnostic testing. However, when a patient has undergone less invasive types of testing, such as magnetic resonance imaging (MRI) and computerized tomography (CT scan), and the test results are inconclusive, that patient may benefit from a discogram, which often provides more definitive test results. If back surgery is warranted, many times this becomes very clear after discography. In some situations, though, positive results obtained from discography has actually prevented patients from undergoing unnecessary surgery.
Like most medical treatments, discography is not recommended for everyone. Patients who take a blood thinning medication (such as Coumadin® or Plavix®), or have an active infection, should not undergo this procedure.
Discography usually takes about 30 to 45 minutes, and is performed either in Dr. Pasi’s medical office or in a hospital room that has imaging equipment. Usually between two and four intervertebral discs are studied during the procedure. The patient is awake the entire time, but a sedative may be given to aid with relaxation, and antibiotics may be administered to help prevent infection.
To begin the procedure, Dr. Pasi uses a local anesthetic to numb the skin and soft tissue overlying each disc. A fluoroscope is used to determine placement of the needle. Then the discs being investigated will be injected one at a time with the dye, to determine which of them are damaged. While this is happening, Dr. Pasi will ask the patient questions for input regarding the level of pain. She will want to know how the pain levels from the injections compare to the patient’s typical, daily back pain. Normally, if a particular disc is responsible for the patient’s back pain, when that disc is injected, the patient will feel pain that’s similar to the back pain experienced on a daily basis. But if the disc is healthy, there will be little or no pain during the injection.
When the test is completed, the needle will be removed, the patient’s skin will be cleansed, and bandages will be applied. The patient will be monitored in a recovery room for about 30 to 45 minutes before being discharged to go home. It is normal to have some pain at the injection site(s) or in the lower back for several hours (and up to 48 hours) after discography. Dr. Pasi will prescribe pain medication to ease the temporary pain caused by the procedure.
It is important to understand that discography is not a treatment for back pain, but rather a valuable diagnostic tool. Figuring out the source of your back pain paves the way for the development of an effective pain management solution.
After you’ve undergone discography, Dr. Pasi will review the discogram and the responses you gave about the pain you experienced during the procedure, and then she will use this information to develop a individualized treatment plan for you, which may or may not include surgery. You will be asked to come in for a follow-up consultation, at which time she will go over the over your test results, along with her treatment recommendations.
If you have additional questions regarding this procedure or if you have serious back pain and would like to schedule a consultation with Dr. Pasi, please call Advanced Pain Consultants at (919) 510-7901 to book your appointment. Don’t live with back pain. Let us help you get your life back. Understanding what’s causing the pain is the first step.
A Holistic Approach to Pain Management