Diagnosing Disk Pain with Discography
Discography is used to determine whether or not back pain is coming from a disk as well as identifying abnormalities in the disk. Abnormalities can include disk herniation, tears or fissures. These abnormalities are clinically significant if, when manipulated, they reproduce the patient's pain.
Patients that have significant back pain that is not relived from conservative pain management techniques are candidates for discography. Conservative pain management for the back usually includes medication, physical therapy and epidural steroid injections. Before a discography, patients should also have had an MRI scan to identify disk abnormalities.
The discography procedure
Discography involves the injection of contrast dye into the center of a disk under X-ray control. It is typically not a painful procedure, but local anesthetics are used to minimize pain. However, because of the very nature of discography, patients with positive discograms will have pain during the disk injection. This will usually subside after a few minutes.
What if discography does not reproduce my pain or does not elicit 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 on a disk will be successful in reducing the patient’s pain. In the event that the discogram does not reproduce pain, other diagnostic interventions could be considered.