SOMA Orthopedics

What are the discs?
The discs are soft, cushion-like pads which separate the hard vertebral bones of your spine. A disc may be painful when it bulges, herniates, tears, or degenerates and may cause pain given the corresponding level. Other structures in your spine may also cause similar pain such as the muscles, joints and nerves. Usually, we have first determined that these other structures are not your sole pain source through history and physical examination, review of x-rays, CT/MRI, and/or other diagnostic injection procedures such as facet and sacroiliac joint injections and nerve root blocks before performing discography.

What is discography and why is it helpful?
Discography confirms or denies the disc(s) as a pain generator. It is a relatively simple procedure that uses an x-ray guided needle to inject contrast dye into your disc. While MRI and CT scans only demonstrate anatomy, they cannot absolutely prove your pain source. In many instances, the discs may be abnormal on MRI or CT scans but not be a source of pain. Only discography, which is a functional test, can tell if the disc itself is a source of your pain. Therefore, discography is done to identify painful disc(s) and help the surgeon plan the correct surgery or avoid surgery that may not be beneficial. In addition to the suspect disc(s), at least one normal disc is chosen to be tested to serve as a baseline or "control." Discography is usually done only if you think your pain is significant enough for you to consider surgery or more advanced treatment options.

What will happen to me during the procedure?
An IV will be started so that antibiotics (to prevent infection) and relaxation medicine can be given. It is important to realize that you will not be "knocked out" for the procedure since it essentially needs the patient's feedback to tell if a disc is painful. You will lie on your back for cervical discography, on your belly for both thoracic and lumbar discography. Your skin will be well cleaned and sterile drapes placed over the area to be examined. Next, the physician will numb a small area of skin which may sting for a few seconds. Next, the physician will use x-ray machine to guide a small needle into your disc. You may feel temporary discomfort as the needle passes through the muscle or near a nerve root. It is important that you communicate with the physician about what you are feeling and not simply move your body in response. The physician may repeat this at several adjoining disc levels. After the needles are in their proper locations, a small amount of contrast dye is injected into each disc. If a disc is the source of your usual pain the injection will temporarily reproduce your symptoms. If a disc is not the source of your pain then the injection will not reproduce your typical symptoms or cause any discomfort.

What should I do after the procedure?Immediately afterwards you may be taken for a CT scan. You should not drive for eight hours following this procedure. You will wait 30-45 minutes after your CT scan to go home. You will be given, if desired, a prescription for pain medication over the next 2-3 days when your muscles may be sore. You can also use your existing pain medication.

General Pre/Post InstructionsYou should not eat or drink for 6 hours before the procedure. If you are an insulin dependent diabetic, please adjust your insulin dosage accordingly. Take your routine medications before the procedure (such as high blood pressure and diabetes medications) with a small sip of water. You may take your regular pain medicine as needed before/after the procedure. If you are on coumadin, heparin, lovenox, plavix, or ticlid you must notify the office so that the timing of stopping these medications can be explained. If you have an active infection or are taking antibiotics, or have a new fever we will need to reschedule the procedure. You will be in the hospital as an out-patient for 2-3 hours even though you see the physician for 20 minutes. You will need to bring a driver with you. You may return to your current level of activities the next day including return to work. You will need to take antibiotics for 5 days after the procedure to prevent any possible infections.