Lumbar discography is a technique used to diagnose lower back pain in patients who have not responded well to conservative treatments. A Lumbar discography is often recommended for patients who have disabling lower back pain, leg pain, groin pain and/or hip pain.
A Lumbar discography, or discogram, is used to create pressure within a sensitive disc to determine if a specific disc is the cause of the patient’s pain.
Usually, general anesthesia is avoided so the patient can communicate the sensations experienced during the test.
The patient is placed on a specialized table which fits within a fluoroscopic (x-ray) unit. The area over the disc spaces that will be examined is marked, the area is disinfected and surrounded with a sterile drape. The fluoroscope will also be sterilely draped and the discographer will be in a sterile surgical gown.
Administration of Local Anesthesia
Local anesthesia is used to numb the tissue that extends from the skin to the disc’s surface. When these tissues are numbed a guide needle is directed towards the disc and will just touch the outer surface of the annulus (the outer edge of the disc).
Through this guide needle a much smaller disc needle is placed into the center of the disc. This process should not be painful.
Pressurizing the Discs
After all of the needles are in place, the discs are pressurized one at a time. Pressurization consists of injecting small amounts of a sterile liquid (usually contrast material (x-ray dye)) into the center of the disc.
During the test the patient will experience either:
- Feeling pressure
- Feeling pain
Pain from the injection is either the familiar pain for which the test is preformed, or an unfamiliar pain caused by the test. The patient’s response will ultimately determine if the disc being tested is the root cause of their pain.
After each level is pressurized, pictures are taken with the fluoroscopic unit and the needles are removed. Usually, a post-discogram CT is taken to document the condition of the disc.
The lumbar discography procedure usually takes less than an hour to perform. The patient may experience soreness from the needle punctures that lasts several days.