What is a discogram?
A discogram is a diagnostic study to help more clearly define the cause of a patient’s pain.
What is the purpose of a discogram?
Pain in the lower back and/or legs can be due to one problem, or a combination of a dozen problems. Sometimes, the predominant cause may not be clear. A discogram is a test to obtain more information. That information can help determine the primary cause of pain which then allows your doctor to determine the best treatment plan to get you better. Sometimes, surgeons specifically request your pain management doctor to perform a discogram so they can figure out exactly where to operate.
How is the procedure performed?
You will be placed on the procedure table. The injection site is sterilized with either iodine or chlorhexadine. The site to be injected is numbed with a local anesthetic, and a needle is directed to the target area. The procedure itself involves placement of a needle into the disc(s) that your doctor suspects is causing your pain. Typically, 3 different discs are tested. X-ray guidance is used to ensure proper placement and positioning of the needle into each of the discs being tested. Once the needle is properly positioned, a small amount of contrast is injected into the disc. You will be asked what you’re experiencing as the contrast is injected into each disc, and specifically if injection of the contrast reproduces any of your usual symptoms. Once each disc is tested, the needle(s) are removed. Once you recover from the procedure, you will be discharged from our facility, and directed immediately to a hospital near you to obtain a CT scan of the same discs. This scan will help your doctor see what the contrast looks like inside the discs, revealing specific problems that may be causing your pain. Your doctor will review the results of the discogram and post-dicogram CT at your next clinic visit.
Will the procedure be painful?
The injection can be painful and we therefore provide the option of receiving IV sedation. IV sedation, combined with local anesthetic, can make the injection nearly pain free. It allows you to remain very still during the procedure, which can also make the injection easier, faster, and more successful. IV sedation will be used while the needle(s) are placed into each of the target disc(s). Once properly placed, sedation will be discontinued so you can be fully alert. It is important for you to be awake for the next part of the procedure (injection of contrast) so that you can provide the doctor with feedback. This part can be painful but it only take a couple minutes. If you decide to have IV sedation, you must have a driver to get you home safely afterwards. In addition, you cannot have anything to eat or drink within 6 hours of your appointment (clear liquids are allowed until 2 hours before the procedure). If you take medications for diabetes, these medications may need to be adjusted the morning of the procedure. Your primary care physician can help you with this adjustment.
What are the discharge instructions?
If you received IV sedation do not drive or operate machinery for at least 24 hours after the procedure. You may return to work the next day following your procedure. You may resume your normal diet immediately. Do not engage in any strenuous activity for 24 hours. Do not take a bath, swim, or use a hot tub for 24 hours (you may take a shower). Call the office if you have any of the following: severe pain afterwards (different than your usual symptoms), redness/swelling/discharge at the injection site(s), fevers/chills, difficulty with bowel or bladder functions.
What are the risks and side effects?
The complication rate for this procedure is very low. Whenever a needle enters the skin, bleeding or infection can occur. Some other serious but extremely rare risks include paralysis and death.
You may have an allergic reaction to any of the medications used. If you have a known allergy to any medications, especially local anesthetics, notify our staff before the procedure takes place.
You may experience any of the following side effects up to 4 hours after the procedure:
- Leg muscle weakness or numbness may occur due to the local anesthetic affecting the nerves that control your legs (this is a temporary affect and it is not paralysis). If you have any leg weakness or numbness, walk only with assistance in order to prevent falls and injury. Your leg strength will return slowly and completely.
- Dizziness may occur due to a decrease in your blood pressure. IF this occurs, remain in a seated or lying position. Gradually sit up, and then stand after at least 10 minutes of sitting.
- Mild headaches may occur. Drink fluids and take pain medications if needed. If the headaches persist or become severe, call the office.
- Moderate to severe discomfort at the injection site can occur. This can last for a few days. and is due to irritation of the area that’s already causing much of your pain. If this occurs, take anti-inflammatories or pain medications, apply ice to the area the day of the procedure. If it persists, apply moist heat in the day(s) following. The irritation and inflammation will resolve in a matter of days, leading to resolution of this pain caused by the procedure.
The side effects listed above can be normal. They are not dangerous and will resolve on their own. If, however, you experience any of the following, a complication may have occurred and you should either contact your doctor. If he is not readily available, then you should proceed to the closest urgent care center for evaluation:
- Severe or progressive pain at the injection site(s)
- Arm or leg weakness that progressively worsens or persists for longer than 8 hours
- Severe or progressive redness, swelling, or discharge from the injections site(s)
- Fevers, chills, nausea, or vomiting
- Bowel or bladder dysfunction (i.e. inability to urinate or pass stool or difficulty controlling either)