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Discography

LUMBAR DISCOGRAPHY

WHAT IS LUMBAR DISCOGRAPHY & WHY IS IT HELPFUL?

Discography is used for surgical planning prior to a lumbar fusion. Discography may confirm or deny that the disc(s) are the source of pain. Your surgeon needs to be absolutely sure that the level or levels being fused are responsible for your pain. This procedure involves placement of a needle into the disc utilizing x-ray guidance and injecting contrast (x-ray dye). The procedure is usually done if the patient’s pain is significant enough for the surgeon to consider surgery.

WHAT ARE DISCS?

The discs are soft, cushion-like pads, which separate the hard vertebral bones of the spine. A disc may be painful when it bulges, herniates, tears, or becomes degenerated.

HOW IS THE PROCEDURE PERFORMED?

Dr. Jagodowicz performs discography in an operating room setting as an outpatient. An IV will be started so that antibiotics (to prevent infection) and relaxation medication can be given. You will be lying on your stomach on a special x-ray table. All precautions will be taken to ensure a sterile environment during the procedure. The areas for discography will be prepped in a sterile fashion and sterile drapes will be applied. A local anesthetic will be used to numb the skin over these areas. Dr. Jagodowicz will direct a small needle(s), using x-ray guidance into the disc(s). When proper placement has been confirmed by fluoroscopy (x-ray), the disc(s) are "pressurized" one at a time. Pressurization consists of injecting small amounts of contrast (x-ray dye) into the center of the disc(s). This is an important part of the study for two reasons. First, injecting contrast into the disc(s) may show pathology that is not otherwise revealed on conventional imaging studies; and secondly, the pressurization of the disc(s) will serve as a provocative test to determine if the disc(s) in question are the source of your pain. You will be awakened at this point and asked what sensation you are feeling. You have three choices: 1. You feel nothing 2. You feel pressure 3. You feel pain. If you feel pain during pressurization, you must respond if the pain is familiar ("that’s my pain") or unfamiliar ("I’ve never felt that pain before"). Your response will aid in determination of which level(s) are involved in your pain process. The entire procedure should take less than one hour.

IS THE PROCEDURE PAINFUL?

You may feel some uncomfortable sensations at times during the pressurization of the disc(s). You will receive sedation during the procedure by an anesthesiologist, and discomfort will be kept to a minimum. Post procedure, you may experience some injection site tenderness for several days. Cool compresses on and off for 15 minute intervals will control any discomfort during the first day. Pain medication will be prescribed as needed.

ARE THERE RISKS OR SIDE EFFECTS FROM THIS PROCEDURE?

Any time there is an injection through the skin, there is a risk of infection. This is why sterile conditions are used for this procedure. Although rare, risks associated with lumbar discography include discitis, epidural abscess formation, possible nerve injury from direct needle trauma, bleeding, possible worsening of pain, and headache.

WHAT ARE MY PRE/POST PROCEDURE INSTRUCTIONS?

Patients should have nothing by mouth for 6 hours prior to the procedure. If you take pain medication or anti-inflammatory medication, you should stop taking them the day of the procedure. Your medicines can be started afterwards if they are needed. You will need a ride home and you should not drive yourself for at least 8 hours following the procedure. If you develop fever the following day(s), notify the office immediately. You can return to normal activities the day following the procedure.