FAQ’s on Lumbar Discogram
What is a lumbar discogram?
Your spinal column is made up of a column of bones (vertebrae) separated by intervertebral
discs. These discs allow the vertebrae to glide over each other, allowing you to flex, bend and twist your spine. Occasionally, the soft, gelatinous center (nucleus pulposus) discs can herniate or extrude through the surrounding fibrous outer layer (annulus fibrosus), compressing nerves and causing irritation, pain, and even muscle weakness.
The spine is composed of the cervical (neck), thoracic (mid-body) and lumbar (lower back) areas. Lumbar (lower back) pain can be assessed through imaging studies such as X-rays, Magnetic Resonance Imaging (MRI) scans, Computerized Tomography (CT) scans, or a lumbar discogram.
The lumbar discogram involves the insertion of needles into the disc, under the guidance of fluoroscopic imaging. Once the needle is inserted into the center of the disc, fluid is injected to pressurize the disc, and the patient response is recorded. If this is the affected disc, the procedure will elicit a pain response. This procedure is repeated in random order for other discs. The discogram also allows the introduction of a contrast medium that will allow leakages in the disc to show up during the CT scan. Studies have failed to show a way to predict response to a discogram by non-invasive means.
When is a lumbar discogram indicated?
A discogram is a done:
- to evaluate an intervertebral disk as the cause of the pain when other imaging studies have failed;
- when the lower back pain is persistent despite treatments;
- when surgical intervention is considered.
How can you prepare for the procedure?
Your physician will advise you on the steps you will need to prepare yourself for the procedure. Feel free to ask any questions you may have about the procedure during the initial interview. Prophylactic (preventive) antibiotics and anti-coagulants (blood thinners) may be prescribed depending on your physician’s assessment.
The procedure is done under local anesthesia, although you may be sedated prior to the procedure to reduce the probability of an unpleasant experience. The procedure requires a sterile technique, so you will be draped in sterile operating linen and the surgical site will be scrubbed.
What are the risks associated with discograms?
You should be aware that there are risks associated with the procedure. The most dangerous complication is the infection of the intervertebral discs. Patients who are immunocompromised (i.e., with weakened immune response) can suffer from discitis or even epidural abscesses. Discograms can also cause the intervertebral disc to herniate, although this is associated with pre-existing weaknesses in the annulus fibrosus. These complications can be managed by going to a skilled and experienced discographer who utilizes a sterile technique and modern procedures and equipment. Needle placement has been shown to be important to the outcome of the procedure, so it’s best to go to a physician with a lot of experience.
Guyer RD, Ohnmeiss DD; NASS. (2003). Lumbar Discography. Spine Journal. Retrieved from: http://www.ncbi.nlm.nih.gov/pubmed/14589214
Scuderi GJ, Brusovanik GV, Golish SR, et al. (2008). A critical evaluation of discography in patients with lumbar intervertebral disc disease. Spine Journal. Retrieved from: http://www.ncbi.nlm.nih.gov/pubmed/18069067
Werner BC, Hogan MV, Shen FH. (2011). Candida lusitaniae discitis after discogram in an immunocompetent patient. Spine Journal. doi: 10.1016/j.spinee.2011.09.004