Discogram Procedure
Overview
Discography, sometimes referred to as a discogram, is an invasive diagnostic test focused on the spine. Physicians use this imaging technique to help pinpoint whether a specific intervertebral disc is linked to ongoing back pain. During the procedure, the physician carefully injects a contrast dye into the nucleus pulposus, which is the soft center of the spinal disc. The dye helps highlight cracks or injuries in the disc, making them visible in imaging tests such as CT scans or X-rays.
Key Details
- Imaging tests used: X-ray, CT scan
- Examines: Intervertebral discs between vertebrae
- Purpose: Locate an injured disc causing discomfort
- Test type: Invasive procedure using diagnostic imaging
Although this test can show disc damage, not every worn disc identified through discography results in symptoms. Because disc problems can be difficult to diagnose with standard imaging alone, discography provides a functional assessment by correlating structural damage with actual pain response.
Reasons for Use
A discogram sometimes helps diagnose long-lasting back pain, especially if the pain continues after treatments like medication or physical therapy. Common reasons for this procedure include:
- Identifying the cause of pain from a herniated or bulging disc.
- Examining suspected degenerative disc disease or other disc injuries.
- Planning for spinal fusion or related surgeries.
- Clarifying ambiguous MRI or CT findings when the source of pain is still unknown.
Discography is not typically a first-line test. Doctors usually recommend it only when other imaging techniques—like MRI or CT—fail to clearly explain ongoing symptoms. It is often used before back surgery to confirm which disc may need removal or repair, helping reduce the risk of unsuccessful outcomes.
Possible Complications and Side Effects
A discogram can lead to some risks, though most are uncommon. These include:
- Infection in or around the disc space
- Allergic reactions to the injected dye
- Bleeding or damage to blood vessels
- Nerve injuries that may cause tingling or numbness
- Headaches after the procedure
- Worsening of existing back pain
This test uses small amounts of radiation. Rarely, severe complications like disc space infection or paralysis can occur. Because the disc is intentionally pressurized during the test, some patients experience a temporary flare-up of symptoms. This reaction can provide useful diagnostic information, but the discomfort usually fades within a few days.
Steps to Get Ready
Before the Test
- Stop taking any blood thinners if told by the healthcare team.
- Review current medications with the doctor to know which ones are allowed.
- Do not eat or drink anything the morning of the test.
Bring These
- An updated list of all medications
- Details of medical history
Other Steps
- Physical exam
- Information about allergies to contrast dye or local anesthesia
Patients should plan to take the day off work and avoid strenuous activity after the procedure. An ice pack may help after the procedure for comfort. The care team might give sedation or a local anesthetic during the process.
What You Can Expect
Patients usually change into a hospital gown and remove any metal jewelry or accessories. The team may give a mild sedative or an antibiotic to help prevent infection and ease nerves. The healthcare team checks vital signs before the exam and helps the patient get comfortable on the table.
Preparation Checklist
- Wear comfortable clothing.
- Avoid eating or drinking before the procedure (if instructed).
- Arrange a ride home after the appointment.
What Happens During the Test
During the procedure, the patient lies on their stomach or side. The care team cleans the skin on the back and gives a local numbing injection to reduce any pain from the needle. The radiologist carefully places a needle into the center of the disc with the help of fluoroscopy, a special type of continuous x-ray imaging.
After the needle is in place, the radiologist injects a contrast dye into the disc. X-ray images or CT scans show how the dye spreads. If the dye leaks outside the center, this may indicate disc damage. The patient stays awake to describe any pain they feel during the injection. This helps the care team know if a disc is likely causing their usual back pain.
Quick Facts
| Step | What Happens |
|---|---|
| Numbing medicine | Reduces discomfort from needle insertion |
| Fluoroscopy & X-rays | Guide the needle and check dye placement |
| Pain reporting | Patient describes pain during dye injection |
The radiologist may test multiple discs during the same visit to identify which one(s) are symptomatic and which are not, offering a comparison that helps refine the diagnosis.
Steps After the Test
After the discogram, the patient stays in the clinic or hospital for observation for about 30 to 60 minutes. The staff monitors for any side effects or unexpected pain. Someone should be available to drive the patient home afterward.
Mild soreness or discomfort near the injection site is normal and usually fades after a few hours. Applying an ice pack wrapped in a towel for 20 minutes at a time can help reduce pain. Patients should keep the area dry and avoid getting the back wet for 24 hours.
Patients are often asked to rest for the remainder of the day and avoid lifting, bending, or twisting for at least 24 to 48 hours. If the patient gets a fever or severe pain in the following days, especially within one to two weeks, they should contact their healthcare provider for advice.
Outcomes
After the discogram, the medical team examines both the images taken and the patient’s description of pain felt during the test. This helps them find which spinal disc might be causing discomfort. The response to pain during the procedure is important, but not the only factor they use.
Most of the time, the medical team reviews the discogram results together with other tests, such as an MRI, CT scan, or a physical exam. This combination helps the healthcare team create a more accurate plan for treatment or surgery.
Key Points:
- The medical team reviews both disc images and pain reports.
- The team rarely uses discogram results alone.
- The team compares additional tests like MRI or CT.
- Results help plan the next steps in care.
A positive discogram result—where the pain matches the patient’s typical symptoms—may support decisions for spinal fusion or disc replacement surgery. However, a negative result can also be valuable by ruling out certain discs as the source of pain.
