Discography is a provocative test in which radiographic contrast is injected into the disc (nucleus pulposus) and the spread of contrast as well as the presence or absence of typical discogenic pain is noted during the injection.

Discography is a tool that can be used to better assess the cause of a patient’s isolated axial back pain. Discography is a common procedure of request among neurosurgeons and orthopedic spine physicians when deciding if a patient needs a spinal fusion or artificial disc replacement at the disc level. Discography can also be used to provide intradiscal therapy to the patient as emerging therapies such as stem cell, PRP have been discussed as a means to repair the internal disc degeneration.

After being prepped the patient is placed on the exam table belly down. The skin is then prepped via sterile technique with antiseptic solution and drapes are placed. A spinal needle is placed through the skin and advanced until it is seated in soft tissues. Once the spinal needle is introduced into the disc there is a notable increase in resistance noted with further advancement. At this point the physician will use check multiple views of the fluoroscopy c-arm to make sure the needle is appropriately placed in the optimal position central to the disc. Once confirmation is made with the appropriate position provocative testing is conducted.

Testing involves injecting a small volume of radiographic contrast (often combined with antibiotic) into the discs. The contrast material is injected under live fluoroscopy to observe the pattern of contrast and its spread within the disc. As the material is injected the physician questions the patient about the presence or absence of pain felt with the injection. Severity of the pain, quality of pain, as well the amount of volume injected to induce pain are noted by the physician as is the contrast spread.

After injection of all levels final imaging is taken of all disc levels injected and patterns of contrast spread are noted. Often after the procedure patients are sent for CAT (computed tomography) scan imaging to further assess the patterns of disc disruption while the contrast is still present.

Most patients will experience an increase of their typical back pain in the days following discography. You may have soreness from the needle punctures that lasts a few days. Once your vital signs are stable, you will be able to go home. Most patients prefer to have a family member or friend drive them for their procedure, however, you may drive yourself to the procedure as long as you are not requesting sedation.