Project Description

Dr. Paul Lynch performs a discography. A discography is a diagnostic procedure to determine the source of chronic back pain.

Watch Pain Doctor Paul Lynch perform the discography procedure live.

­­­­­­Discography is a procedure that is used for diagnostic purposes to determine what type of condition may be causing neck pain and lower back pain. This technique is also referred to as a discogram and it was used for the first time by Scandinavian doctors in the 1940s to identify spinal disc lesions that were causing pain. In the 1960s, doctors in the United States improved upon the procedure through clinical research. As a result, the use of discography greatly surpassed a number of other methods that were being used for diagnostic purposes during that time.

Currently, doctors mainly use discography for patients who have neck pain and axial low back pain that may or may not be radiating into the extremities. If other forms of noninvasive assessments such as magnetic resonance imaging (MRI) have been inconclusive a discogram may be utilized. This is especially the case if the other assessments were unable to rule out possible causes such as facet or sacroiliac disease. Current studies show that discography effectively helps doctors identify spinal disc abnormalities that lead to painful symptoms. Furthermore, it is used to locate damaged or inflamed discs in individuals who may need surgery.

How Is Discography Performed?

Before the discography procedure begins, the patient is requested to lie on a table equipped with an X-ray and the targeted region of the skin is sterilized. A local anesthetic is also injected directly into the targeted area. The doctor will use an imaging device called a fluoroscope to carefully and accurately insert a needle into spinal discs that may have abnormalities, and then a contrast dye is delivered.

If the injection results in pain that is reminiscent of the patient’s previous pain, this indicates that the discogram has probably identified the problem. On the other hand, the injection will not result in intensified pain if the spinal disc is not responsible for the patient’s symptoms. This process takes about one hour to complete.

The International Spine Intervention Society, the American Society of Interventional Pain Physicians, and the National Ankylosing Spondylitis Society all promote the use of discography as a safe and effective diagnostic approach for the evaluation of neck and back pain. Furthermore, current statistics from a meta-analysis show that discography adheres to standards that have been established by the aforementioned organizations.

Clinical research has repeatedly demonstrated the benefits of discography for patients and clinicians when it is compared to the results from analyses such as an MRI, especially for back pain. Furthermore, it has been concluded that although an MRI is highly effective at identifying spinal disc abnormalities, discography does so with greater efficiency in terms of locating the actual pain source. An additional advantage of discography is its ability to prevent unwarranted back or neck surgery. In particular, a number of surgeons have reported that the results from discography tests circumvented the need for invasive surgeries such as a lumbar fusion. They also mentioned that locating and subsequently treating the appropriate disc is essential in relieving a patient’s pain.

Although discography is not an intensely invasive method, it is associated with a few complications. The complications are rare and include:

  • Bleeding
  • Infection
  • Nerve damage
  • A hoarse voice
  • Paralysis
  • Temporary numbness
  • Spinal headaches

Some patients also report experiencing discomfort or pain for approximately one week following the procedure. Cold compresses may be applied to the area and over-the-counter pain medication may be taken if needed.

Conditions Related To Discography

A common health issue in the United States that most often leads to treatment is back pain. More specifically, it affects the lives of about 80% of adults at some point during their lifetime. There are many cases in which the source of pain cannot be determined. Various conditions may cause neck pain or back pain, such as:

  • Infections
  • Osteoarthritis
  • A herniated or bulging disc
  • Spondylolisthesis
  • Arthritis
  • Spinal stenosis
  • Compression factures

A variety of spinal diagnostics, radiographic imaging techniques, and medical assessments help doctors rule out certain conditions that may be causing pain. If it is believed that a problematic spinal disc is responsible, a discogram can confirm this diagnosis.

A common problem with spinal discs occurs when a disc bulges or completely ruptures and causes spinal nerves to become inflamed. This is called disc herniation, and trauma or the gradual degeneration of disc tissue may cause this condition. Discography can reveal whether this condition is present.

Conclusion

Over the years, discography has become a very effective tool for the diagnosis of conditions that are causing a patient’s lumbar back pain or neck pain. Being able to accurately pinpoint the source helps clinicians and their patients make more informed decisions regarding the form of treatment that should be utilized. Sometimes it is discovered that a patient does not need surgery due to the results. Therefore, patients who have received evaluations with techniques such as an MRI who were not provided with useful results are often recommended to undergo discography. There have been cases where surgeons have reported that the results of a discogram helped a number of their patients avoid invasive surgical procedures.

References

  1. Borthakur A, Maurer P, Fenty M, et al. Magnetic resonance imaging and discography pressure as novel biomarkers for disc degeneration and low back pain. Spine Diagnostics. 2011;36(25):2190-2196.
  2. Chen JY, Ding Y, Lv RY, et al. Coorelation between MR imaging and discography with provacitive concordant pain in patients with low back pain. Clin J Pain. 2011;27(2):125-130.
  3. Manchikanti L, Boswell MV, Singh V, et al. Comprehensive evidence-based guidelines for interventional techniques in the management of chronic spinal pain. Pain Physician. 2009;12:699-802.
  4. Provenzano D. Diagnostic Discography. What is the Clinical Utility? Curr Pain Headache Rep. 2012;16:26-32.
  5. Reeves R, Furman M. Discography’s role in low back pain. Pain Manage. 2012;2(2):151-157.
  6. Medscape Reference: Discography – Retrieved Nov. 2013 from http://emedicine.medscape.com/article/1145703-overview