Discograms
Intervertebral (spinal) discs help provide flexibility to our spine. They also lessen the effect of impact on our spine by cushioning the bony vertebrae. With injury or age, these discs can become damaged and the supporting ligaments surrounding them weaken. A discogram is a diagnostic procedure, not a treatment, that helps determine whether a specific spinal disc is the source of chronic back pain. Unlike an MRI or CT scan that shows structural abnormalities, a discogram evaluates whether a disc is painful when pressure is applied directly to it.
The procedure involves injecting a contrast dye into one or more spinal discs under fluoroscopic (X-ray) guidance. If the injection reproduces your usual pain, that disc may be the pain generator. The dye also helps visualize any internal disc damage, such as tears or leaks.
Who Benefits from Discogram Injections
A discogram may be recommended if you have:
- Chronic low back pain or neck pain lasting longer than 3–6 months
- Pain that has not improved with conservative treatments (e.g., physical therapy, medications, injections)
- Prior imaging (MRI/CT) that shows disc abnormalities but is not definitive
- You are being evaluated for spinal fusion surgery or another invasive procedure
- Your provider needs to confirm which disc(s) are actually causing pain before surgery
Discograms are typically performed only after other diagnostic options have been exhausted.
What to Expect
- Preparation: You’ll be instructed not to eat or drink for several hours before the procedure. An IV line may be started for medications.
- Positioning: You’ll lie face down on an X-ray table. The skin over your spine will be cleaned and numbed.
- Injection: Under fluoroscopic guidance, a thin needle is inserted into the center of one or more discs. A contrast dye is injected to pressurize the disc and assess pain response. This is the most important part of the procedure, and you must concentrate on what you are feeling. There are essentially three choices:
- You feel nothing
- You feel pressure
- You feel pain
If you feel pain from the injection, the pain is either:
- Familiar pain, which translates into “ouch, that’s my pain!”
- Unfamiliar pain, which belongs to someone else or translates into “ouch, I’ve never felt that pain before.”
After each level is pressurized, pictures are taken with the fluoroscopic unit and the needles are removed.
- Duration: The procedure usually takes 30–60 minutes.
- Discomfort: You may feel pressure or pain during the injection, especially if the disc is damaged. This helps your provider identify problematic discs. Sedation is often light so you can accurately report your pain response.
After the Procedure
- Recovery Room: You’ll be monitored for a short time to ensure there are no immediate side effects.
- Soreness: Temporary back pain or soreness at the injection site is common for 1–3 days.
- Pain Flare: Some patients experience increased pain for a short time, especially if damaged discs were injected.
- You will want to plan for a ride home from the procedure.
Recovery and Aftercare
- Rest: Take it easy for the rest of the day. Avoid heavy lifting, bending, or twisting for 24–48 hours.
- Ice and Medication: Use an ice pack to reduce soreness and take prescribed or over-the-counter pain relievers as needed.
- Return to Normal Activities: Most patients can resume light activities within a day or two, but full return to physical exertion may take several days.
- Follow-Up: You’ll have a follow-up appointment to review your discogram results and discuss next steps, such as surgery or alternative treatments.
Risks and Considerations
Although discograms are generally safe, they carry some risks, including:
- Temporary or increased back pain
- Disc injury or inflammation
- Infection (discitis)
- Allergic reaction to contrast dye
- Bleeding or nerve irritation (rare)
You’ll be screened for risk factors before the procedure and monitored closely afterward.
Important Note
A discogram is not a treatment, but a diagnostic tool. Its purpose is to confirm whether one or more discs are responsible for your chronic pain, especially before considering surgical options. It is typically used in complex cases where imaging and physical exams have not pinpointed the source of pain.