Provocative discography is a procedure that is used to help accurately diagnose discogenic pain (pain coming from the disc). The decision to proceed with discography is made when it is unclear if pain is coming from the discs, or which disc is actually causing pain. An MRI demonstrates the disc anatomy, but does not tell if the damaged disc is causing pain. This procedure gives the physician an actual picture of the disc with an injected contrast agent, so defects such as tears and degeneration can be seen. Just as importantly, the procedure helps the physician determine whether or not the patient has concordant pain (the same pain the patient has at home) and if the disc is the source of the patient’s pain.
The results of this test determine the appropriate course of further treatment. Surgeons commonly send patients for this procedure to make their surgery more precise in both the lumbar and cervical spine. Ask your surgeon about discography prior to spinal fusion.
How is discography performed?
Discography, an invasive procedure, is performed under fluoroscopy (similar to x-ray, except in real time) in a sterile environment. To help you relax during the procedure, mild sedation can be administered. An antibiotic is also given intravenously before the procedure
You will be positioned with pillows for support and comfort, on your side, or in another position. The injection sites are cleaned with an antiseptic and the skin numbed using an anesthetic.
Under fluoroscopic guidance, a contrast agent is injected into the center of selected discs through a small needle. The contrast enhances the disc’s anatomical characteristics and may spread outside the disc if abnormal. As each disc is injected with contrast, you are asked to describe your symptoms, such as the intensity and type of pain experienced. When discography replicates your symptoms, it is called a positive discogram. If symptoms are not replicated, it is a negative discogram. Discography can be uncomfortable, although symptoms are temporary.
The procedure may take 30-45 minutes, depending on the number of discs examined.
What happens after the test?
You may experience some discomfort, or pain, for a few hours after the procedure. If your pain becomes intense, please contact us so we can quickly help you to be more comfortable.
The images from the procedure as well as the information obtained from the procedure will be forwarded to your surgeon. The hope is that the results of the discogram allow you to have a smaller surgery or avoid a surgery that may not help.
To Learn More
If you have questions about discography, or are interested in learning about treatment options to manage your pain, please contact our pain management experts at The Spine and Pain Institute of New York in Manhattan, New York and Staten Island, New York. We would be happy to make an appointment for a consultation and provide additional information about other treatment options.