FACT SHEETS
Lumbar Discogram (Discography)
Lumbar discography (discography) is a diagnostic procedure specifically designed to identify painful intervertebral discs that may be the source of back pain. The procedure consists of inserting specialized needles into the center of intervertebral discs and injecting contrast dye to pressurize the discs.
If the patient experiences pain during the injection that reproduces their typical pain symptoms, this suggests that the disc is the source of pain. This confirms the diagnosis by allowing physicians to correlate symptoms with specific discs and imaging findings.
This diagnostic procedure targets the nucleus pulposus (central portion) of the disc directly, allowing for assessment of disc integrity and pain generation. The provocation aspect of discography specifically refers to its ability to reproduce a patient's typical pain pattern during the test.
Unlike therapeutic injections, discography is purely diagnostic and is typically performed when other diagnostic tests like MRI cannot definitively identify the pain source. Discography results help guide treatment decisions for interventions such as spinal fusion, disc replacement surgery, or intradiscal therapies when non-surgical treatments have failed to provide adequate relief.
THE DIAGNOSIS FOR USE OF THE LUMBAR DISCOGRAPHY PROCEDURE
Low back pain commonly manifests as localized axial pain with or without referred pain into the buttocks, hips, or legs. Internal disruption of intervertebral discs (internal disc disruption) can be a significant source of back pain but may not be readily apparent on standard imaging studies such as MRI scans.
To identify painful discs that may be the source of back pain, we perform a provocative discography procedure. This involves inserting specialized needles into the center of several intervertebral discs and injecting contrast dye to pressurize them while monitoring the patient's pain response. A disc is considered "concordant" and potentially painful if the injection reproduces the patient's typical pain pattern.
Research indicates that discography can provide valuable diagnostic information when standard imaging fails to identify a clear pain generator, particularly in patients being considered for invasive procedures like spinal fusion or disc replacement. Discography helps surgeons determine which specific disc levels should be treated.
For patients with axial back pain of suspected discogenic origin, lumbar discography is used primarily as a diagnostic tool to guide decision-making regarding surgical intervention. This procedure is typically reserved for patients who have not responded adequately to conservative treatment measures and are being evaluated for specific interventions targeting the intervertebral discs.
DISCOGRAPHY PROTOCOL
The primary purpose of discography is to determine whether specific discs are the source of your pain. Consequently, implementing a consistent pain measurement method is essential. The Visual Analog Scale (VAS) is commonly used, rating pain from 0 to 10—where 0 represents no pain and 10 indicates extreme pain that completely inhibits thinking, movement, and normal functioning.
Patients should continue their regular medication schedule prior to the procedure, except for blood thinners which may need to be temporarily discontinued (only after consultation with your physician). For the procedure to be appropriately evaluated, patients must clearly communicate during the test whether the pain produced matches their typical pain pattern, as this "pain concordance" is crucial to the diagnostic value of the procedure.
THE PROCEDURE
Discography requires inserting specialized needles through the skin under fluoroscopic (X-ray) guidance. The needles are carefully guided into the center of each intervertebral disc being tested. Contrast dye is injected to pressurize the disc while monitoring both the patient's pain response and the pattern of dye spread within the disc, which may reveal internal tears or disruptions.
It's perfectly normal to feel anxious about the procedure. However, you can be reassured that discography is performed routinely by experienced specialists. Unlike most other spinal procedures, discography is designed to temporarily reproduce your pain as part of the diagnostic process. The procedure typically takes 45-60 minutes to complete depending on the number of discs tested. Some increased pain may occur for 24-48 hours after the procedure, but this typically resolves with over-the-counter pain medications and rest.