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What is a Discogram?

A "Discogram" is a form of Spinal Injection which doctors perform to get more information about a patient's Spinal Disc. Spine Specialists often try to identify a specific Disc or Discs as the culprit of a patients pain, especially . MRI information about the patient's Spine can help narrow things down, however they only show the Anatomy of the Spine, rather than pinpoint a patient's pain. In some patients the information from the patient's history, physical examination and MRI does make the diagnosis, however in others there is still some uncertainty about which Spinal Disc if any is the culprit of the patient's symptoms. As an example, in some patients the MRI shows more than one abnormal Disc, yet only one Disc may require surgery.

In general, Discograms are performed by either a Pain Management Specialist (Anesthesiologist, Physical Medicine and Rehabilitation Specialist, Radiologist, etc.) or a Spine Surgeon. These doctors have special training in placing the needle into Spinal Discs and interpreting the results of the injection. Discograms can be performed for Discs in the Neck (Cervical Spine), Mid-Back (Thoracic Spine, and Low-Back (Lumbar Spine).

So, how is a Discogram done? After the Skin over the Spine is cleaned with Antiseptics, the Skin is typically anesthetized with a Local Anesthetic. A Discogram Needle is then placed into each Disc with the help of a "live" (second by second pictures) X-Ray machine (Fluoroscope). Typically, more than one Disc is targeted by the Discogram. The Needle is placed into a normal and at least one abnormal Disc. Once the Needle is properly placed and verified with the X-Ray machine, Contrast Dye (and sometimes Anesthetic) is injected directly into the Disc. The Contrast Dye is important since this allows the doctor to see the dye inside the Disc with the help of the X-Ray machine. A normal Disc collects the Dye in its Center without leakage, while an abnormal Disc may allow the dye to leak into the Disc's outer ring (annulus fibrosus) or entirely outside the Disc. The second important piece of information from the Discogram is whether or not a patient feels pain when the dye is injected into the Disc. If pain is felt, it is very important to know if this is the same pain a patient typically feels. This may point to this specific Disc as the culprit of the patient's symptoms. A normal Disc should not cause this type of pain during a Discogram injection. Another piece of information doctors sometime obtain from a Discogram is a pressure reading inside the Disc. The Disc pressure can also help in the determination of a Disc is abnormal. Lastly, some doctors inject an Anesthetic into the Disc at the end of the Discogram to see if a patient will get pain relief from this procedure.

All together then, Discograms are performed to find out if a specific Disc or Discs are responsible for a patient's pain which can help determine if a Disc Surgery could relief this pain.

While Discograms are not a foolproof way to find out which Disc in the Spine is abnormal or painful, it can be a useful tool together with the history and examination of the patient as well as MRI Images. The hope is that this test can improve the likelihood of a successful Spinal Disc Surgery.