What is discography?
Discography is an examination that evaluates whether the intervertebral disc in your lower back is the cause of your pain.
What can we see with discography?
By placing a needle in the intervertebral disc we can see whether there are any abnormalities present in the intervertebral disc and whether these abnormalities might explain why you feel pain. On the X-ray below you can see an example of a discography of the intervertebral discs between the third (L3) and fourth (L4) lumbar vertebrae, between the fourth (L4) and fifth (L5) lumbar vertebrae and between the fifth lumbar vertebra (L5) and the sacrum (S1). The three black lines are the needles whose tips have been inserted into the intervertebral discs. The stars at the end of the needles indicate the contrast fluid inside the intervertebral discs.
In the Figure:naald = Needle
When do I need discography?
If you have lower back pain, with or without radiation to one or both legs, that has not responded to other means of treatment and, after examining you, your pain physician thinks that the intervertebral disc is the main cause of your pain symptoms, then he may decide to perform a discography on you.
What should I be aware of before undergoing discography?
- Any of the following situations should be reported to your pain specialist if he proposes discography:
- If you are pregnant: since X-ray equipment is used, pregnant women may not undergo discography.
- If you are ill or have a fever on the day of treatment you cannot undergo discography, in which case a new appointment will have to be made.
- If you are allergic to iodine, wound plasters, anaesthetics or contrast fluids, you should notify your pain specialist before the appointment for treatment is made.
- If you are taking blood thinners, you should notify that your pain specialist before the appointment for treatment is made. He will then consider whether the use of certain medications should be ceased temporarily.
How should I prepare for discography?
- No special preparations, such as an overnight bag, are necessary because the treatment is carried out on an outpatient basis.
- You may eat before treatment and take your normal medication.
- N.B.: this does not include blood thinners, as mentioned above.
- Make sure you have someone to take you home, because you may not drive for 24 hours.
How does discography work?
- After you have reported to the surgical day-care centre, you will be taken to the operating theatre.
- There, you will be placed on a bed and prepared for discography.
- After a drip has been inserted and the necessary monitoring equipment (heart rate, blood pressure) put in place, you will be asked to lie on your stomach.
- The treatment is performed under local anaesthesia, possibly with the addition of a mild sedative to ensure that you are calm and relaxed.
- Because discography compares a healthy intervertebral disc with the affected one, at least two intervertebral discs are always examined (the affected intervertebral disc and one or two normal ones).
- Using fluoroscopy, a needle is inserted into the intervertebral disc.
- Then a small amount of dye is injected into the intervertebral disc.
- During the procedure, you will sometimes be asked questions. In particular, you will be asked whether it hurts when the dye is injected, and even more importantly, whether you can pinpoint where this pain is.
- If anaesthetic is injected into the intervertebral disc, you will be asked to say when this pain disappears.
- As a protection against infection, some form of antibiotic will be administered using a drip.
- The treatment generally takes about one hour.
- After treatment, you will be taken to the recovery room.
- You will remain there for further controls for approximately one hour.
When will I be discharged from hospital?
- Before you are discharged, the treating pain specialist will give you the results of the discography.
What are dangers and side effects of discography?
After discography, the following complications or side effects can occur:
- Temporary loss of strength or numbness in an arm or leg. This is a consequence of a nerve being anaesthetised. This feeling will wear off within a few hours.
- If the needle touches a blood vessel, bruising may occur. This can sometimes cause pain.
- There is a very slight risk of infection in an intervertebral disc.
What after care is necessary?
- You may not drive a car following treatment. Therefore, you must ensure that you have someone to take you home.
- There will be a plaster over the puncture site. This may be removed on the evening of treatment or the following day.