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Discography is considered for patients who have disabling low back pain, neck pain, and arm or leg radiation pain when
other conservative diagnostic methods and treatments have failed.
Anatomy of the spine
Understanding the anatomy and physiological function of the spine is the key in evaluating a person with back pain. The
bony spine is positioned so that individual vertebrae (bones of the spine) provide a flexible support structure while also
protecting the spinal cord. Certain conditions that can produce chronic pain affecting the vertebrae include Spinal
stenosis, vertebral body fractures, Osteoporosis, Osteoarthritis, Spondylolisthesis, neoplasms (Primary vs. metastatic
lesions), and infections.
Separating each individual vertebrae are discs that act as cushions to minimize the impact that the spinal column
receives. Since the discs are designed to be soft and provide support, they have a tendency to herniate posterior
(backwards) through the outer disc segment and ligaments. Bulging and leaking discs often cause irritation to the
adjacent nerves. Disc disease is one of the most common causes of chronic back pain and accounts for approximately
10% of all low back pain complaints. Disc disease may be acute, herniation resulting from trauma, or more commonly
chronic in nature. Degenerative disc disease is a process, which is due to a thinning and degeneration of the discs over
time.
Procedure
Before the procedure begins, your skin will be appropriately cleaned to decrease the risk of infection. A small needle with
local anesthetic will then be injected into your skin to numb the area before a larger needle is inserted. A larger needle is
then inserted through the anesthetized skin and is positioned near the outer layer of the disc. Fluoroscopy, real time X-
ray, is used in order to assure proper placement of the needle. A contrast solution is injected into the disk and your
response to the injection is observed at different locations. If pain is experienced that is similar to your chronic pain
condition, then it is possible that your doctor has located the source of your pain. This process is typically repeated at
two additional levels. The procedure generally takes about thirty minutes to an hour. Your pain physician may instruct
you to go for a CT exam directly after the discogram to better localize contrast dye spread.
Benefits
Although MRI is considered a very good method for showing disc abnormalities, it does not show direct causes of pain. A
study in 2007 concluded that the use of Discography is more effective than MRI for detecting intervertebral disc ruptures
as well as other conditions (Montes Garcia 2007).
Since discography is considered a minimally invasive procedure it is performed when your physician has a high suspicion
that your disc may be the cause of your pain. Typically patients who undergo discography have not gotten satisfactory
pain relief from other measures including medication, physical therapy and modified activities.
MRI and CT scans show anatomical dysfunctions whereas discography is able to pinpoint the locations producing the
pain. Sometimes abnormal discs found on MRI or CT scan can be completely asymptomatic and do not cause pain. It is
well known that minimally affected discs can produce severe pain and may not be treated accordingly base on imaging
alone (MRI/CT scan).
Risks
As with all medications and interventions, there is always a risk of complications. Typically discography is considered low
risk with minimal complications. Although uncommon, discitis can be severe. Discitis is an infection of the disc and
presents as pain. Other risks are bleeding, hematoma, headache and increased pain.
Outcome
After the results from your discography are reviewed, your pain physician will devise a treatment plan that will increase
your level of function as well as decrease or eliminate your pain. The doctor’s at Arizona Pain Specialists are board
certified in treating pain conditions like yours.
A clinical researcher concluded in 2007 that discography is a useful imaging and pain evaluation tool in patients with
chronic spinal pain and that, “at our current level of understanding, discography is thought of as the best tool to evaluate
disc-related pain” (Buenaventura 2007).
If you are suffering from chronic back pain that has been refractory to other treatments contact Arizona Pain Specialists
today to see if you can benefit from their innovative treatments.
Journal Articles
Evocative lumbar discography Montes García C, Nava Granados LF. Acta Ortop Mex. 2007 Mar-Apr;21(2):85 PMID:
17695763
Discography: over 50 years of controversy Wichman HJ. WMJ. 2007 Feb;106(1):27 PMID: 17393754
Systematic review of discography as a diagnostic test for spinal pain: an update Buenaventura RM, Shah RV, Patel V,
Benyamin R, Singh V. Pain Physician. 2007 Jan;10(1):147- PMID: 17256028
www.spine.org
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RECLAIM YOUR LIFE.
| Arizona Pain Specialists 9787 N. 91st Street, Suite 101 Scottsdale, AZ. 85258 Phone: 480-563-6400 |
Arizona Pain Specialists 2007. All rights reserved
Discography
by Nicole Berardoni M.D, Paul Lynch M.D, and Tory McJunkin M.D
Discography is a diagnostic tool used to determine whether
certain discs of the spine are the source of a patient’s neck or
back pain. Low back pain affects approximately 80% of the
general population at least sometime during their lifetime. It is
also the fifth leading cause of physician visits, as well as the
leading cause of work-related disability. Discography has been
used to diagnosis the cause of low back and neck pain, especially
when non-invasive imaging, such as magnetic resonance imaging
(MRI), does not reveal abnormalities consistent with the pain
symptoms (Wichman 2007).
by Nicole Berardoni M.D, Paul Lynch M.D, and Tory McJunkin M.D
Discography is a diagnostic tool used to determine whether
certain discs of the spine are the source of a patient’s neck or
back pain. Low back pain affects approximately 80% of the
general population at least sometime during their lifetime. It is
also the fifth leading cause of physician visits, as well as the
leading cause of work-related disability. Discography has been
used to diagnosis the cause of low back and neck pain, especially
when non-invasive imaging, such as magnetic resonance imaging
(MRI), does not reveal abnormalities consistent with the pain
symptoms (Wichman 2007).
Discography: Contrast is seen
filling discs.
filling discs.
Reclaim Your Life. Call for an
appointment Today.
appointment Today.
If you want more
Information about how
Arizona Pain Specialists can
help you just Click Here.
Information about how
Arizona Pain Specialists can
help you just Click Here.
Book I - Pain Syndromes
Chapter 1 Low Back Pain
Chapter 2 Neck Pain
Chapter 3 Cancer Pain
Chapter 4 Headaches
Chapter 5 Spinal Stenosis
Chapter 6 Sciatica
Chapter 7 Arthritis
Chapter 8 Fibromyalgia
Chapter 9 Motor Vehicle Injuries
Chapter 10 Complex Regional Pain
Syndrome
Chapter 11 Vertebral Body
Fractures
Chapter 12 Hip and Leg Pain
Chapter 13 Diabetic Peripheral
Neuropathy
Book II - Interventional Procedures
Chapter 14 Epidural Steroid
Injection
Chapter 15 Facet Injections/Medial
Branch Blocks
Chapter 16 Radiofrequency Ablation
Chapter 17 Spinal Cord Stimulator
Implants
Chapter 18 IntraDiscal
Electrothermal Therapy (IDET)
Chapter 19
Vertebroplasty/Kyphoplasty
Chapter 20 Discography
Chapter 21 Percutaneous
Discectomy
Chapter 22 Occipital Nerve Block
Chapter 23 Sympathetic Block
Chapter 24 Stellate Ganglion Block
Chapter 25 Intrathecal Pump
Implants
Chapter 26 Caudal Steroid Injection
Chapter 27 Adhesiolysis
Chapter 28 Cervical Steroid
Injection
Chapter 29 Sacroiliac Joint
Injections
Chapter 30 Celiac Plexus Block
Chapter 31 Head and Neck
Procedures
Chapter 32 Joint Injections
Chapter 33 Continuous Catheter
Nerve Blocks
Chapter 34 Peripheral Nerve
Stimulation/Field Stimulation
Chapter 35 Disc Denervation
Book III Other Treatments
Chapter 36 Medication Management
Chapter 37 Acupuncture
Chapter 38 Prolotherapy
Chapter 39 Botox
Chapter 40 Massage
Chapter 41 Alternative and
Complementary Medicines
Chapter 42 Exercise and Nutrition
Counseling
Chapter 43 Prayer
Chapter 44 Cognitive Behavioral
Therapy
Chapter 45 Group Therapy
Chapter 46 Biofeedback
Chapter 47 Chiropractic
Manipulations
Chapter 48 Vitamin Supplements
Chapter 49 Customized
Pharmaceutical Formulations
Chapter 50 Hormone Therapy
Frequently Asked Questions
Chapter 1 Low Back Pain
Chapter 2 Neck Pain
Chapter 3 Cancer Pain
Chapter 4 Headaches
Chapter 5 Spinal Stenosis
Chapter 6 Sciatica
Chapter 7 Arthritis
Chapter 8 Fibromyalgia
Chapter 9 Motor Vehicle Injuries
Chapter 10 Complex Regional Pain
Syndrome
Chapter 11 Vertebral Body
Fractures
Chapter 12 Hip and Leg Pain
Chapter 13 Diabetic Peripheral
Neuropathy
Book II - Interventional Procedures
Chapter 14 Epidural Steroid
Injection
Chapter 15 Facet Injections/Medial
Branch Blocks
Chapter 16 Radiofrequency Ablation
Chapter 17 Spinal Cord Stimulator
Implants
Chapter 18 IntraDiscal
Electrothermal Therapy (IDET)
Chapter 19
Vertebroplasty/Kyphoplasty
Chapter 20 Discography
Chapter 21 Percutaneous
Discectomy
Chapter 22 Occipital Nerve Block
Chapter 23 Sympathetic Block
Chapter 24 Stellate Ganglion Block
Chapter 25 Intrathecal Pump
Implants
Chapter 26 Caudal Steroid Injection
Chapter 27 Adhesiolysis
Chapter 28 Cervical Steroid
Injection
Chapter 29 Sacroiliac Joint
Injections
Chapter 30 Celiac Plexus Block
Chapter 31 Head and Neck
Procedures
Chapter 32 Joint Injections
Chapter 33 Continuous Catheter
Nerve Blocks
Chapter 34 Peripheral Nerve
Stimulation/Field Stimulation
Chapter 35 Disc Denervation
Book III Other Treatments
Chapter 36 Medication Management
Chapter 37 Acupuncture
Chapter 38 Prolotherapy
Chapter 39 Botox
Chapter 40 Massage
Chapter 41 Alternative and
Complementary Medicines
Chapter 42 Exercise and Nutrition
Counseling
Chapter 43 Prayer
Chapter 44 Cognitive Behavioral
Therapy
Chapter 45 Group Therapy
Chapter 46 Biofeedback
Chapter 47 Chiropractic
Manipulations
Chapter 48 Vitamin Supplements
Chapter 49 Customized
Pharmaceutical Formulations
Chapter 50 Hormone Therapy
Frequently Asked Questions