DISCOGRAM

The Benefits

• Identification of Pain Source: A discogram can help identify if a particular disc causes pain. By injecting a contrast dye into the disc, the procedure can reproduce the patient’s pain symptoms, and identify a particular disc as the pain generator.  Therefore, this information can provide valuable data for doctors to make treatment decisions and determine the most appropriate course of action.
• Surgical Planning: Discograms can aid in surgical planning for individuals with severe disc-related problems. If conservative treatments do not provide sufficient relief, a discogram can help identify which specific discs cause pain. Consequently, this information is useful for surgeons in deciding whether a particular disc should be repaired, removed, or replaced during surgical intervention.
• Accurate Diagnosis: For individuals with complex or atypical pain patterns, a discogram can help provide a more accurate diagnosis. Furthermore, it can distinguish between multiple discs as potential sources of pain, and rule out discs not generating symptoms. This can help avoid unnecessary treatments or interventions and focus on addressing the root cause of the pain.

Primary Purpose of a Discogram

A discogram, also known as discography, is a diagnostic procedure used to identify the cause of back pain or neck pain. It involves injecting contrast dye into the intervertebral discs of the spine to assess their structural integrity and identify any abnormalities that may be causing pain. Intervertebral discs are fibrocartilaginous cushions that separate spinal vertebrae. They have two parts:

• A soft gel-like center called the nucleus.
• A tough fibrous outer wall is called the annulus.

Discograms are typically used to diagnose conditions such as:

• Disc herniation: The soft inner core of a spinal disc pushes through the tough outer layer irritating nearby nerves and causing pain.
• Degenerative disc disease: The gradual wear and tear of the intervertebral discs, leading to pain, stiffness, and reduced mobility.
• Discogenic pain: Pain originating from the intervertebral discs themselves, often due to tears or fissures in the disc.
• Spinal disc tears: Tears or fissures in the outer layer of the disc, can cause pain and inflammation.
• Vertebral fractures: Fractures or cracks in the vertebrae, which can cause instability and pain.
• Annular tears: Tears in the tough outer layer (annulus fibrosus) of the intervertebral discs.
• Disc infection (discitis): Infection of the intervertebral discs, which can cause severe pain and inflammation.
• Post-surgical evaluation: Assessing the integrity of spinal discs following spinal surgery to determine the cause of persistent pain or complications.

It’s important to note that while discograms can provide valuable diagnostic information, they are invasive procedures. Discograms are typically used when other diagnostic tests, such as MRI or CT scans, have not provided conclusive results.  Additionally, discograms carry some risks, including the potential for increased pain or complications.  They are usually performed only after careful consideration by the treating physician.

How Should I Prepare for a Discogram?

Preparing for a discogram involves several steps to ensure the procedure goes smoothly and reduces potential complications. Here’s a detailed guide to help you get ready:

Fasting Guidelines

• No solid food: Avoid eating any solid foods after midnight on the night before your scheduled test.
• Hydration: You may be allowed to drink clear liquids up until a few hours prior, but follow your doctor’s specific instructions.

Transportation Arrangements

• Drive assistance: Arrange for someone to drive you to and from the hospital. You won’t be able to drive yourself post-procedure due to sedation effects.

Comfortable Clothing

• Dress appropriately: Wear comfortable clothing, such as a warm-up suit, sweats, or shorts. You’ll be asked to change into a hospital gown upon arrival.
• Valuables: Leave all jewelry and valuables at home to prevent any loss.

Medication Disclosure

• Inform your doctor: Let your doctor know about any medications you’re currently taking.
• Adjustments: You might need to stop taking certain medications, especially pain relievers, 7 to 10 days before the procedure as they can affect blood clotting.

Hospital Procedure Overview

• IV Line: An intravenous (IV) line will be placed in your arm before the test.
• Discussion and Consent: The radiologist or nurse will discuss the procedure, explain potential risks, answer any questions you might have, and obtain your consent through signed forms.

Emotional Preparation

• Stay calm: Although the discogram can be uncomfortable, it typically only takes 30 to 40 minutes. Keeping a relaxed mindset helps the process go more smoothly.

Following these steps can help ensure that you are well-prepared for your discogram, making the experience as stress-free as possible.

What Does a Radiologist Do?

A radiologist is a medical doctor who specializes in diagnosing and treating diseases and injuries through medical imaging techniques. These professionals use a variety of imaging technologies, such as X-rays, MRI (magnetic resonance imaging), CT scans (computed tomography), and ultrasound, to get detailed pictures of the inside of the body.

Key Responsibilities

• Interpreting Images: Radiologists meticulously analyze medical images to identify abnormalities, injuries, or diseases. Their expertise allows them to interpret subtle findings that might go unnoticed by the untrained eye.
• Performing Procedures: They often perform image-guided procedures, such as biopsies and the placement of catheters, using imaging technology to guide them precisely, which enhances the safety and effectiveness of the procedure.
• Consulting with Other Physicians: Radiologists work closely with other healthcare providers to discuss findings, recommend further imaging if needed, and contribute to the overall diagnosis and treatment plan for the patient.
• Ensuring Image Quality: Part of their job includes ensuring that the imaging equipment is functioning correctly and that the images obtained are of high quality, minimizing the need for retakes and exposing patients to the least amount of radiation necessary.

Work Environment

Radiologists typically work in hospital radiology departments, outpatient imaging centers, and specialized clinics. Depending on their subspecialty, they might also be involved in teaching, research, or a combination of clinical practice and academic work.

In summary, radiologists play a crucial role in modern medicine, providing essential insights that guide the treatment and management of a wide range of health conditions.

Who Performs a Discogram?

A discogram, also known as a discography, is typically performed by a board-certified radiologist specializing in medical imaging. This procedure can take place in various settings, including the hospital’s radiology department or an outpatient imaging center.

Often, you might also encounter interventional radiologists, who have extensive training in minimally invasive, image-guided procedures, carrying out the discogram. These specialists ensure accurate needle placement and contrast dye injection, both critical for clear imaging results.

In some cases, an anesthesiologist or a nurse may assist to ensure patient comfort, particularly if sedation is used during the process. The combined expertise of these professionals helps in diagnosing spinal disc issues with precision and care.

How to Conduct a Discogram

Prior to the operation, medication will help you relax.  Then the doctor will apply a local anesthetic to numb the area of the back.  Upon numbing the area, the doctor injects the dye into the nucleus pulposus (the very center of the intervertebral dick).  Most importantly, The doctor uses a fluoroscope to see your spine, and the needle gets inserted into the correct disc space.

Fluoroscopy, also known as a C-arm, is an imaging device that uses X-rays or other radiation to view structures in the body in real-time. This technology allows healthcare professionals to see “live” images of internal organs, bones, and other tissues. By providing real-time imaging, it ensures the precise placement of instruments, such as needles, during medical procedures.

This real-time capability is particularly crucial for procedures involving delicate areas like the spine, ensuring accuracy and safety. In addition, once the needle gets placed inside the damaged disc, the doctor places a small amount of fluid to increase pressure on the disc.  If this test causes pain similar to your back or leg pain, it reveals that the disc causes the pain. 

Limitations of a Discogram?

Unfortunately, the discogram does not show the bones or nerves very well inside the intervertebral disc. Doctors do not frequently use this test; however, if an MRI fails to find a problem, disc doctors will recommend it. Doctors also rely on the discogram when considering disc surgery.

The risks?

The risks associated with a discogram include infection inside the disc and an allergic reaction to the dye. Discograms require X-rays, which use radiation. In large doses, radiation can increase the risk of cancer. The vast majority of patients who undergo X-rays will never get enough radiation to worry about cancer. Only doctors whose patients must get hundreds of X-rays over many years become concerned. This test has more risks associated with it than most. This provides the reason that doctors prefer to use “noninvasive” tests first, such as MRI and CT scans.

What Happens After a Discogram?

Following a discogram, you’ll be escorted to a comfortable room for a 30-minute observation period. This crucial time allows medical staff to monitor your immediate recovery and ensure that you’re stable.

Important Post-Procedure Tips

1. Hydrate Well: It’s essential to drink plenty of water or other fluids. Keeping hydrated helps your body flush out the contrast dye used during the procedure more efficiently.
2. Homeward Bound: You’ll be allowed to go home the same day. Ensure you have someone to drive you, as you’ll need to rest.
3. Take It Easy: Plan to take it easy for the first 24 hours after the test. Avoid any strenuous activities to give your body ample time to recover.
4. Managing Discomfort: Some individuals may experience a headache following the procedure. For pain relief, avoid taking aspirin. Instead, opt for over-the-counter options like ibuprofen or acetaminophen.

Quick Recovery Checklist

• Rest: Ensure you get plenty of rest.
• Hydrate: Drink lots of fluids.
• Monitor Symptoms: Keep an eye on any symptoms and contact your healthcare provider if anything unusual occurs.

By following these guidelines, you can help facilitate a smoother recovery process after your discogram.

Why Choose Southwest Scoliosis and Spine Institute

The spine is the specialty of our doctors and surgeons at the Southwest Scoliosis and Spine Institute. The physicians understand your concerns, can answer your questions regarding your condition, and know how to use their specialized knowledge and advanced training to assist you.  Richard Hostin, MD, Devesh Ramnath, MD, Ishaq Syed, MD, Shyam Kishan, MD, and Kathryn Wiesman, MD, have many years of training and experience in Spine and Back Pain for kids, adolescents, and adults, and can help their patients get back to living the life they enjoy.

A few of the many reasons why patients choose the Southwest Scoliosis and Spine Institute.

• Expertise in the spine: Our team of specialists is recognized as spine experts.  Furthermore, they specialize in the diagnosis and treatment of spinal conditions, ensuring the best possible care for their patients.
• Cutting-edge technology: Our practice uses the latest technology and techniques to diagnose and treat a wide range of conditions.  In addition, we use minimally invasive procedures that reduce pain and promote faster recovery.
• Comprehensive care: Our practice offers a full range of services, from diagnostic imaging and physical therapy to surgery.  Accordingly, we ensure that patients receive complete, seamless care for their spinal conditions.
• Dedicated facilities: Southwest Scoliosis and Spine Institute is dedicated to providing patients with a safe and comfortable environment.

Finally, our board-certified physicians and fellowship-trained orthopedic surgeons use the full range of treatments to treat spine patients. Southwest Scoliosis and Spine Institute doctors and surgeons are experts with offices in  Dallas, Plano, and Frisco, TX.  They offer cutting-edge technology, comprehensive care, and dedicated facilities to ensure the best possible care for their patients. Call today to make an appointment.