Initial Preparation for the Discogram Procedure You now have a second chance to ask questions or decide whether or not to proceed. Next, the discographer will talk with you to review the relevant anatomy and discuss the procedure in much greater detail. Despite what you’ve been told, the discogram is not designed to create agony. This is the time to relate any and all horror stories you may have heard from medical (and non-medical) experts. All of your questions and concerns should be addressed and answered. History and Physical ExamĪ nurse or other healthcare professional conducts the initial interview. While different discographers may vary the procedure slightly, the following provides an overview of modern technique for a lumbar discogram diagnosing back pain. Since a spine fusion procedure carries a significant level of risk and healing time, the more information that can be obtained prior to back surgery the better. If the fused levels were not initially painful, spine surgery will not help, and the patient will be left with a fused spine and probably still be in pain. The spine surgeon needs to be absolutely sure that the level or levels being fused are responsible for the patient’s pain. A spinal fusion procedure that is designed to obliterate an internally disrupted, painful disc (pain generator) would not be the procedure of choice if pressurization of the disc didn’t reproduce the patient’s clinical discomfort. The lumbar discogram, if performed properly, is designed to induce pain in a sensitive disc. The Lumbar MRI and CT myelogram are very sensitive anatomic tests but are not very specific in defining actual pain generators. It is well known to discographers that a really abnormal looking disc may not be painful and a minimally disrupted disc may be associated with severe pain. It is impossible to definitively diagnose a painful disc without performing a discogram. It should be understood that the discogram is less about the anatomy of the disc (what the disc looks like) and more about its physiology (determining if the disc is painful). When a variety of spinal diagnostic procedures have failed to elucidate the primary pain generator, these individuals may benefit from lumbar discography especially if spine surgery is contemplated. Lumbar discography is considered for patients who, despite extensive conservative treatment, have disabling lower back pain, groin pain, hip pain, and/or leg pain. A discogram is basically a very subjective test, and if there are no experienced discographers available, then the spine surgeon may forego the test since a poorly done discogram does not yield any useful information. Ordering the procedure depends on access to a skilled discographer. The indications for getting a discogram prior to a lumbar fusion surgery are extremely variable amongst spine surgeons. This article does not extol the use of discography rather it addresses some aspects of the procedure that may make a patient more at ease with what is an uncomfortable exam. The procedure’s antagonists feel the responses evoked from disc pressurization are not useful in evaluating back pain patients.The protagonists of discography believe the information gleaned from this examination is unobtainable any other way.This diagnostic procedure – also called a discogram – is a controversial one. The most common use of discography is for surgical planning prior to a lumbar fusion. Lumbar discography is an injection technique used to evaluate patients with back pain who have not responded to extensive conservative (nonsurgical) care regimens.
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