What is discography?
Discography involves the injection of contrast dye into the center of a disc under x-ray guidance. It is strictly a diagnostic procedure. Local anesthesia and sedation are used during the procedure.

What is the purpose of discography?
Discography is used to determine whether or not pain is coming from a disc and for identifying abnormalities in the disc. Abnormalities can include disc herniations, tears and fissures. These abnormalities are clinically significant when they cause or contribute to a patient’s pain.

Which patients are candidates for discography?
Patients who have significant pain and have undergone conservative management are candidates for discography. Conservative management for the lower back usually includes medications, physical therapy and interventional therapy (injections). Patients should also have had an MRI scan to identify disc abnormalities. Typically, patients with lower back discogenic pain experience pain with sitting and bending forward. However, it should be kept in mind that the symptoms are not specific. Patients may have other symptoms such as pain with extension or rotation of the back.

Are discograms painful?
Discography is usually not very painful in normal discs. Local anesthetics and sedation are used. However, because of the very nature of discography, patients with positive discograms will have pain during disc injection. This will usually subside after a few minutes. Narcotic medications may be given after discography has been completed.

Why can’t an MRI scan or x-ray show where my pain is coming from?
In some cases, abnormalities on imaging studies are very profound and correlate very well with the patient’s pain. However, most abnormalities on imaging studies are nonspecific and do not identify the pain generator. In fact, there was a New England Journal of Medicine study that showed that a significant number of patients without lower back pain had disc bulges.

Are there any risks or side effects associated with discography?
There are few risks associated with discography. Since the procedure is performed under strict sterile conditions, the risk of infection is minimal. In addition, patients are given antibiotics for the procedure. Patients usually have some injection site tenderness that lasts up to one week.

What if the discography does not reproduce my pain or does not bring forth any pain during injection of the disk?
This indicates that it is not likely that pain is coming from the disk. This can even be true if the disk is herniated or has a fissure. The reproduction of pain is the single most important factor in determining whether a subsequent intervention (such as the IDET procedure or surgery) on a disk will be successful in reducing the patient’s pain. In the event that the discogram does not reproduce pain, consideration should be made for other diagnostic interventions.

What if the discogram is positive?
The options for patients with discogenic pain currently include minimally invasive spine procedures and another option is surgery.