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Lumbar Discogram

What does “Lumbar Discogram” mean?

Here is the meaning of each word:

  1. Lumbar: the part of our spine located in the low back.
  2. Discogram: a procedure where medication is injected into a disc to diagnose of it is painful and diseased.

Altogether, “Lumbar Discogram” means injecting medication into a disc in the low back to see if it is painful and diseased.

Why is a Lumbar Discogram done?

A discogram is performed to get information about the disc, beyond what an imaging study such as an MRI can give. The MRI scan will show the disc but does not tell the doctor if it is painful. Sometimes disc look relatively normal on an MRI scan but are actually diseased and painful. A discogram can tell the doctor if a particular disc is painful or diseased. Also, the doctor can see if the medication injected into the disc has “leaked out” of the disc, which could mean that there is a tear in the outer ring of the disc (annulus). The doctor may also be able to tell if the disc is herniated. Some doctors also inject a local anesthetic into the disc in hopes of anesthetizing the disc. This way, the patient may have relief of their usual back pain after the procedure which could help verify that this disc was responsible for the patient’s pain.

Often more than one disc is tested to see which disc is responsible for the patient’s symptoms.

How is a Lumbar Discogram done?                             

Here are the steps of how a Lumbar Discogram is done:

  1. The patient will receive an intravenous (IV) catheter before the procedure. Antibiotics are given through the IV to prevent an infection. Relaxing medication (sedation) is also commonly given. The amount of relaxing medication has to be kept low. Otherwise the patient may not be able to tell if they feel pain when medication is injected into a diseased disc. The doctor needs to know what the patient feels when the medication is injected into the disc.
  2. The patient is taken to a Procedure Room or Operating Room for the procedure.
  3. The patient is placed on the stomach (prone).
  4. The low back is cleaned with a sterile surgical solution and sheets (drapes) are placed to keep the area clean.
  5. The doctor performing the procedure often wears extra protection against infection, such as a surgical mask, gown and gloves.
  6. An X-Ray machine is used extensively for this procedure.
  7. A small amount of local anesthetic is injected under the skin.
  8. A specialized needle (spinal or procedure needle) is placed through the skin and advanced with the help of the X-Ray machine into the disc itself.
  9. At this point, the patient is instructed that medication is about to be injected into the disc. The patient is informed to tell the nurse and doctor exactly what is felt when the medication is injected into the disc.
  10. The medication contains a contrast dye (fluid which looks dark on an X-Ray). Other medications such as antibiotics or local anesthetics are also often included.
  11. The patient’s response to the injection is noted and recorded.
  12. The X-Ray pictures of the contrast dye in the disc are saved. The appearance of the dye in the disc is recorded.
  13. Usually more than one disc is injected for a discogram to be able to compare the patient’s response to other discs. Often at least one healthy appearing disc is chosen for comparison. This way the doctor can tell what the patient feels when a normal disc is injected. This should not be painful.
  14. At this point, the needles are withdrawn
  15. Band-aids are placed.
  16. The patient is then taken to a Recovery Area for observation.

How long does it take to complete this procedure?

The procedure can take 10-15 minutes to complete for each disc level in the spine.

How do patients benefit from this procedure?

As a patient, the benefit is mainly that the doctor can get information about the discs in the spine. This procedure is not done to relieve pain from a diseased disc for the longer term, but rather gain information about it. Knowing which disc is painful and diseased helps the patient and doctor make a plan of how to treat it. Patients may have pain from the procedure for a period of time afterwards. This will usually get better by itself within several days.