Lumbar Discography
A specialized test that helps identify whether a specific disc is the source of chronic low back pain, when that answer will change your treatment.
What is discography?
The discs between your vertebrae can wear down and become painful. MRI often shows changes in several discs, but it can’t always tell which one, if any, is causing your pain.
Discography is a provocative test: contrast dye is gently injected into one or more discs under X-ray to see whether it reproduces your usual pain. A painful disc next to a disc that doesn’t hurt helps pinpoint the source. A CT scan afterward often shows tears in the disc wall.1
How it works
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X-ray guidance
After numbing the skin, a thin needle is guided into the center of each disc being tested.
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Gentle pressure
A small amount of contrast dye is injected into each disc, one at a time.
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Your feedback
You tell us whether you feel pain and whether it matches your usual pain. You won’t know which disc is being tested.
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Clear answer
Your responses, with the imaging, show which disc is likely causing your pain.
Weighing the benefits and risks
When it helps
Discography is used only when its results will guide a decision, such as whether to consider a disc treatment like VIA Disc NP or to plan surgery.
An important risk
In a 10-year study, discs that had been punctured during discography showed faster wear and more herniations than untested discs.2 For this reason, we recommend discography only when the information is truly needed.
What to expect
Before your test
Tell us about your medications, especially blood thinners, and any allergies. An antibiotic is usually given to lower the risk of infection. Please don’t take extra pain medicine on test day so your responses are accurate.3
During your test
You lie on your stomach with light sedation, so you stay relaxed but able to answer questions. Testing usually takes 30 to 60 minutes.
After your test
Increased back pain for a few days is common. You’ll need a driver. Call us right away for fever, chills, or severe, worsening back pain, which can be signs of infection.
Common questions
Why do I have to be awake?
The test depends on your answers. Light sedation keeps you comfortable, but you need to be able to tell us whether each disc reproduces your usual pain.
Will the test make my pain worse?
It reproduces your pain briefly during testing, and soreness can last a few days. Your usual pain should return to its baseline.
What happens after the results?
Your physician will review the results and imaging with you to decide on the next step, which may include a disc treatment, another procedure, or surgical referral.
Will insurance cover it?
Coverage varies, and some plans don’t cover discography. Our staff will check your benefits and request any required prior authorization.
Talk with a specialist about chronic low back pain
Our physicians will review your history and imaging to decide whether discography, or another approach, will best guide your care.
New pain management patients need a referral. Your provider can fax it to 870-706-2428.
Risks
Risks include temporary increase in back pain, headache, bleeding, nerve irritation, and infection of the disc (discitis), which is rare but serious. Puncturing a disc may speed up its wear over time.2 Your physician will review the risks with you before your test. Individual results vary.
Sources
- Sayed D, et al. The American Society of Pain and Neuroscience (ASPN) evidence-based clinical guideline of interventional treatments for low back pain. J Pain Res. 2022;15:3729-3832. doi:10.2147/JPR.S386879
- Carragee EJ, et al. Does discography cause accelerated progression of degeneration changes in the lumbar disc: a ten-year matched cohort study. Spine. 2009;34(21):2338-2345. doi:10.1097/BRS.0b013e3181ab5432
- Narouze S, et al. Interventional spine and pain procedures in patients on antiplatelet and anticoagulant medications (second edition). Reg Anesth Pain Med. 2018;43(3):225-262. doi:10.1097/AAP.0000000000000700
Illustration: Blausen.com staff, “Medical gallery of Blausen Medical 2014,” WikiJournal of Medicine, CC BY 3.0, cropped.