Discrogaphy

Discography is a study that is used to answer two questions:

1. Which disc (or discs) is painful?
2. What is the specific anatomy of the disc?

As a diagnostic procedure, its usefulness is almost unmatched. It allows your doctors to correlate your pain to abnormal anatomy. No other diagnostic test does this reliably (even MRI). This has been shown by many studies in the medical literature.

Therefore, in order to diagnose your pain and plan future therapy, your physician may request a discogram.

This Xray shows needles in the lower three lumbar discs. Dye has been injected.

L3-4 disc space is normal. There was no pain at all with injection.

L4-5 disc space shows a collection of dye in the back of the disc. This disc was painful. This was unexpected, as the MRI was normal at this level.

L5-S1 disc space shows abnormal collections of dye throughout the disc. This was a painful disc.

This procedure is performed under fluoroscopy so that precise needle placement can be assured. You will have an intravenous (I.V.) catheter placed so that medication can be given to you before and during the procedure. You will be awake during the procedure so that you can communicate with us regarding your pain. Generous local anesthetic is injected into the back muscles to make needle placement as comfortable as possible. When correct placement is assured, the discs are injected with a solution containing X-ray dye. Normal discs will not hurt. Abnormal discs may be painful.

After the test, a CAT scan is obtained of the discs. This is the very best view of the internal anatomy of the discs that we will ever have. It is much better than MRI.

This is a CAT Scan of an abnormal disc. The Xray dye (arrow) has spread out through a painful fissure in the disc.

Discography can also be done in the cervical spine to evaluate neck pain and in the thoracic spine to evaluate pain in the mid-back.

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