What Is Discography?

Discography refers to a diagnostic technique that is performed in order to identify a condition that is causing lower back pain or neck pain. This diagnostic tool is also called a discogram and it was initially used in 1940 by Scandinavian clinicians to locate lesions along the spine that were causing serious pain. During the 1960s, clinicians working in the United States performed clinical research regarding discography that led to the advancement of this technique. Subsequently, discography became an optimal diagnostic method by the early 1970s.

Discography is currently utilized to diagnose the cause of axial low back pain, or neck pain that is or is not accompanied by pain in the extremities. Noninvasive evaluations such as magnetic resonance imaging (an MRI) are usually conducted initially and if the results are inconclusive then discography may be recommended. This type of diagnostic tool becomes especially useful when other evaluations are unable to pinpoint whether diseases of the sacroiliac or facet joints may be responsible for the pain.

Research has repeatedly demonstrated the ability of discography to effectively diagnose abnormalities in spinal discs that result in serious pain. In addition, inflamed or damaged discs can be accurately located through the use of this technique.

How Is Discography Performed?

Procedure-PreperationIn preparation for discography, a clinician sets up an IV or an intravenous delivery of anesthesia to help patients who are anxious feel more relaxed.

After the IV has been set up, the patient is positioned on a table that is X-ray equipped.

The surface of the skin over the affected area is then sterilized and injected with a local anesthesia.

hardware block procedureNext, a needle will be carefully inserted into the correct position while using a real-time X-ray that is referred to as a fluoroscope. A liquid, such as contrast dye, is then injected directly into the region where abnormal spinal discs are believed to be located. If an injection into a spinal disc results in an increase in pain that is similar to the patient’s initial pain, then it is an indication that the discogram has pinpointed the problem area. However, if the patient does not feel an increase in pain it means that an abnormal spinal disc is not the problem. The procedure is usually complete within one hour.

Numerous organizations that are dedicated to pain research and management have reported that discography effectively and safely diagnoses the probable causes of back and neck pain. This diagnostic tool is also currently utilized to assess cervical pain and lower lumbar pain. In addition, a recent meta-analysis study that presents discography statistics mentions that this method strictly adheres to clinical standards for acceptable diagnostic procedures.

Studies repeatedly show that discography is more beneficial than some other analytical techniques (e.g., an MRI) at producing helpful results for various painful conditions, such as back pain. Moreover, the clinical studies explain that MRIs, although highly efficient at revealing abnormalities in spinal discs, are not as effective as discography at pinpointing the actual causes of a patient’s pain.

Discography is especially beneficial in that it often helps individuals avoid unnecessary surgery. In some cases, surgeons have even stated that positive test results from a discogram have led to the prevention of more invasive surgical procedures such as lumbar spinal fusions. In addition, they explained that accurately identifying and then treating a spinal disc is critical for providing patients with significant relief.

bulging discThis procedure is minimally invasive, but similar to other treatments, is described to pose certain risks. The following risks may occur although they are rare:

  • Spinal headaches
  • Temporary numbness
  • Paralysis
  • Bleeding
  • Nerve damage
  • Infection
  • Voice that becomes hoarse

Patients may also feel mild pain or discomfort that persists for about one week after undergoing discography. Over-the-counter pain relievers may be used as well as cold compresses.

Conditions Related To Discography

back painAmong people living in the United States, back pain is a primary health problem. This condition actually affects more than 80% of individuals at one point in time during adulthood. Many different conditions may lead to neck or back pain.

These include:

spinal-disk-herniatedDifferent medical evaluations, radiographic imaging screenings, and spinal diagnostic tools can be used to identify what condition is responsible for the patient’s discomfort. If an abnormal disc is suspected, then discography may lead to the identification of the appropriate disc. Spinal discs often rupture or begin to bulge due to the gradual wear and tear of the tissue, or blunt trauma. If this occurs, spinal nerves become damaged and transmit constant pain signals to the brain. This condition is known as disc herniation. Discography can be used to accurately diagnose this condition.

Conclusion

Discography is a useful diagnostic method that helps doctors understand the nature of their patient’s persistent neck or back pain. Once an accurate diagnosis is made, the patient and doctor can discuss the best method of treatment and in some cases avoid having to discuss surgery. Individuals who have undergone various assessments for their chronic pain and received inconclusive results may benefit from undergoing discography as it has been shown to be much more accurate than other methods, such as MRIs. Surgeons have even reported that positive results that were obtained from a discogram have prevented some of their patients from undergoing unnecessary surgery.

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

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