FAQs on Lumbar Discogram in Nashville TN

An intervertebral disc is a unique structure of the spine that allows for motion, supports the bony vertebrae, and bears weight. The central disc portion is called the nucleus pulposus, which is a jelly-like material. The nucleus is surrounded by hard tissues, which are called the annulus fibrosis. A lumbar discogram is a diagnostic procedure where contrast material is injected into the spinal disc to diagnose disc damage or degeneration.

Why is the lumbar discogram done?

Chronic low back pain is identified as the most common cause of disability for people ages 45 to 65 years. For many people with low back pain, one or more intervertebral discs cause the problem. The lumbar discogram is done to determine if a damaged or degenerated disc is responsible for the pain. Because many structures of the spine can cause pain, the discogram is the only way to determine disc involvement.

How does a damaged disc cause pain?

When there is an injury to a disc, or with degeneration or age, the wall of the disc tears, cracks, or loses integrity. A damaged or diseased disc is called degenerative disc disease or internal disc disruption. When the wall of the disc weakens or protrudes out, this causes nerve compression or irritation. Nerve involved results in pain felt at as deep backache, or radiating pain into the buttock, thigh, and/or leg on the affected side.

Who should have a discogram?

According to the North American Spine Society (NASS), the discogram is used for patients who have:

  • Negative diagnostic imaging tests
  • Suspected intervertebral disc abnormalities
  • Persistent back pain
  • Potential benefit from spinal fusion surgery

What can I expect before the lumbar discogram?

Before the lumbar discogram, you should not eat or drink after midnight. However, you are permitted to take necessary medications with small sips of water. Be sure to wear comfortable clothing and leave jewelry and other valuables at home.

In addition, you will need someone with you to drive you home. When you arrive at the medical facility, a nurse will go over the risks and benefits and have you sign a consent form. Prior to your procedure, you must discuss your medical conditions and medications with the doctor, as certain blood-thinning agents are held prior to the discogram.

How is the lumbar discogram performed?

A nurse will place an IV catheter in your arm to administer sedative medication to help you relax during the procedure, and for some patients, protective antibiotics are given. You will be positioned on your side, and the back is cleansed with an antiseptic solution at the lowest region, as the doctor usually injects 2-3 of the lowest lumbar discs.

The skin and deeper tissues are numbed using a small needle and anesthetic. The injection needles are positioned into the discs using x-ray guidance. If the disc is normal, the contrast material will remain in the center of the disc, but with tears and cracks, the contrast dye will spread out of the disc. There may be slight discomfort when discs are injected, and the doctor questions you on the rate of intensity of pain, as each disc is injected.

What can I expect after the lumbar discogram?

After the lumbar discogram, a computed tomography (CT) scan is performed on the procedure area. This allows the doctor to see the pattern of contrast spread through and/or out of the disc. In disc degeneration, widespread contrast spreading is noticed throughout the disc space. You can expect to be monitored for around 30 minutes after the procedure. We recommend the use of ice packs to the injection site to relieve discomfort.

What are the side effects, risks, and complications associated with a discogram?

The lumbar discogram is a remarkably safe procedure. Side effects associated with this procedure include pain, discomfort at the injections site, and dizziness, which all are temporary. In addition, there is a slight risk for allergic reaction to medications or contrast dye. Other rare complications include nerve damage, bleeding, infection, and blood vessel injury.

Resources

Carragee EJ, Tanner CM, Khurana S, Hayward C, et al. (2000). The rates of false-positive lumbar discography in select patients without low back symptoms. Spine, 25(11):1373–80.

Motimaya A, Arici M, George D, & Ramsby G. 2000). Diagnostic value of cervical discography in the management of cervical discogenic pain. Conn Med, 64(7):395–8.

Walker J, Abd OE, Isaac Z, & Muzin, S Discography in practice: a clinical and historical review. Curr Rev Musculoskeletal Med, 1(2), 69-83. doi:  10.1007/s12178-007-9009-9