Discogram Testing

A discogram is an imaging test used to find the source of pain. It is also called a discography. A discogram shows whether one damaged disc in the spine is causing the pain. Padda Institute has X-Rays, MRI, and CT scans right at the center. We find the root cause of pain first. We take your history and do an exam. We review X-Rays and CT’s/MRI’s. We may use diagnostic injections such as sacroiliac & facet joint injections or nerve root blocks. Only then do we perform discography.

Soft, cushion-like discs separate the hard bones of your spine. During a discogram, dye is injected into the soft center of one or more discs. The shot sometimes causes pain in your neck, mid-back, low back and arms, chest wall, belly, and legs. Dye runs into any cracks in the outer wall of the disc. Those cracks then show up on an X-ray or CT scan. But discs with wear and tear may not cause any symptoms. That is why a spinal discogram might not always be useful.

A discogram is an invasive test. It is rarely used to find the cause of back pain. Your doctor may suggest one if your back pain lasts despite conservative care like medicine and physical therapy. Before spinal fusion surgery, some doctors use a discogram to decide which discs will be removed. But discograms are not always right about which discs cause back pain. So many doctors lean on other tests, such as MRI and CT scans, to find disc problems and guide treatment.

In general, discograms are safe. The risk of problems is the same as with any medical procedure. The risks include

• Infection and an allergic reaction to the dye
• Worsening of chronic back pain
• Headaches
• Injury to nerves or blood vessels around the spine

You may need to stop blood thinners for a while before the procedure. Your doctor will tell you when. Do not eat or drink the morning of the test.

The discogram is done with imaging equipment in a clinic or hospital. The discogram can take up to 60 minutes, based on how many discs are tested. Plan to spend up to three hours there.

You will be awake during the procedure. No sedation is used; you stay awake under local anesthetic so you can report what you feel. Doctors may also give antibiotics to prevent infection.

For the discogram, you will lie on your side or belly on a table. Your doctor may numb your skin so the needle hurts less. Your doctor watches the discogram needle go in using fluoroscopy (live X-ray). Fluoroscopy puts the needle into the center of the disc more exactly and more safely. Next, a contrast dye is injected into the disc. Then an X-ray or CT scan shows whether the dye has spread. If the dye leaks outside the disc’s center, the disc has some wear and tear. That wear may or may not be the source of your pain. If the dye stays inside the center, the disc is normal. If a disc is causing your back pain, the injection usually brings on pain like your daily back pain. If a disc is normal, the injection causes little pain. You will be asked to describe and rate your pain as you go.

The discogram only finds the problem. It does not treat it. You must be able to talk to your doctor and say what pain you feel. You will get enough medicine to be comfortable, but not enough to sleep.

You will stay in the procedure room for 30 to 60 minutes so we can watch you. Then you can go home; most patients drive themselves. It is normal to feel pain at the shot site or in the low back for a couple of hours. An ice pack on the area for 20 minutes can help. Keep your back dry for 24 hours.

Doctors at Padda Institute study the images and what you reported about your pain. That points to the source. The specialist uses it to plan treatment or surgery.

We never rely on a discogram alone. A disc with wear and tear may not be the one causing the pain. And pain during a discogram can vary a great deal from person to person. So when we build a plan for back pain, we usually pair the discogram with other tests. Those include an MRI or CT scan and a physical exam.