Lumbar Discography

What Is There to Know About This Famous Procedure?

Lumbar discography is used in the evaluation of lower back pain to determine the cause of low back pain. Lumbar discography is a generally safe procedure able to determine whether or not there is a damage of any kind present in the discs of the lumbar spine. Conditions such as herniated disc (disc herniation), protrusion, degenerative disc disease, disc extrusion can be identified. Spinal stenosis can occur in cases where herniated disc is present.

The anatomy of the spine

The spine is normally divided into three sections – the cervical, the thoracic, and the lumbar spine. Each of these sections is formed by individual bones called vertebras. There are 7 cervical, 12 thoracic, and 5 lumbar vertebras. The vertebras have certain processes such as the spinous and the transverse processes that help the vertebras form joints with each other and the ribs. In between each vertebra, there is a fibrous disc that separates the vertebras. Each disc is formed by a hard layer, called annulus, and a soft center called the nucleus.

What is Lumbar discography

Lumbar discography is a minimally invasive diagnostic procedure . It is also referred to as lumbar discogram. Lumbar discography was first developed in 1948 when it was used as an investigative technique for the treatment of herniated nucleus pulposus (disc herniation) a condition in which part or the whole nucleus penetrates through a weak part of the disk, leading to back pain and nerve root irritation. Since then, numerous improvements have been made on the topic of Lumbar discography and its methods and techniques in order to achieve better results. Lumbar discography helps doctors to determine if the back pain originates from a diseased or damaged disc. We are talking about a rather safe and accurate diagnostic technique. Lumbar discography is usually performed only after the back pain has not been eliminated with the use of conservative treatments and physical therapy.

The indications for Lumbar discography

There are many scenarios that require a proper Lumbar discography to be performed in lower back pain. In the following, we will list some of the most common scenarios in which Lumbar discography is performed as a part of the diagnostic process.

• Persistent lower back pain after all of the conservative treatment methods and physical therapy have been used to address the issue
• Persistent lower back pain presents for longer than 3 months
• Other possible causes for lower back pain have been ruled out
• Surgery is being planned, and the spinal surgeon wishes to get a better look into the anatomy of the spine and the condition of the discs to determine surgical target

The contraindications for Lumbar discography

As for most procedures – both diagnostic and curative, there are conditions in which these procedures should not be or must not be performed. These conditions are known as contraindications. In the following, we will list some of the most common contraindications for Lumbar discography.

• Pregnancy
• Allergy to contrast medium, antibiotics, and local anesthetics
• Present infection – either localized or systematic
• Known psychological issues of the patient
• The inability of the patient to cooperate and understand what is demanded from him/her as a part of the Lumbar discography
• Many medical conditions – psychological and physical that increase the risk of possible complications afterward and during the procedure itself

How is Lumbar discography performed?

The patient is given sedation during needle placement to ensure comfort. Once the needles are in place, it is very important that the patient is able to respond while Lumbar discography is being performed during testing. Maintaining the patient in an awake state is required so that the patient can report to the doctor when he/she feels pain.

The patient lays on his/her abdomen or side. A sedative through the vein will be given in order to achieve relaxation. Next, an antibiotic is given as well in order to prevent an infection from occurring. The skin around the lumbar spine is properly cleaned. A local anesthetic is inserted using a needle in the lumbar spine. This will reduce the pain that the patient will experience as the needle or needles are inserted through the skin.

Using a needle, the doctor inserts a contrast dye in the center of the discs of the lumbar spine one at a time. To have a clear vision of where exactly the needle being inserted, an imaging technique known as fluoroscopy is used. Fluoroscopy is one of the best imaging techniques that are both safe to be used and effective, providing a clear, precise image of the lumbar spine during the procedure. As soon as the contrast dye is inserted into the center of the discs, the doctor, using a CT scan or X-ray reviews how the contrast dye spread into the discs.

If the dye stays in the center of the disc, that disc is considered to be normal and healthy. However, if the dye spreads outside the disc, that disc is considered to be damaged. These effects are properly seen on the CT scan and the X-ray. In addition, as soon as the doctor inserts the needle in the abnormal discs, the patient will relate if they feel discomfort whether these symptoms are the same as their usual pain. The patient is also asked to rate the pain.

After the procedure, you might be asked to stay in order to discuss the findings of the procedure. After a period of recovery the patient is discharged home from the outpatient facility. Many patients are worried that they still experience pain after the effects of the local anesthetic wear off. It is, in fact, normal to still feel a little pain for several hours after the procedure at the injection site. A tip that we can give you is to apply an ice pack to the injection site and hold it for around 15 to 20 minutes. However, if you develop severe pain at the injection site a few days or weeks after the procedure has taken place, please contact your doctor right away.

How to get prepared for Lumbar discography?

In order to get prepared for the Lumbar discography, we recommend you to talk and ask your doctor whatever interests you about this procedure. Your doctor will advise you which medications should and should not be used in the period before and after the Lumbar discography takes place. You will be asked to avoid any food and drinks on the day that your Lumbar discography is scheduled. The procedure is performed at an outpatient facility and patients are usually asked to stay for around three hours. The procedure itself lasts for 30 to 60 minutes; however, there are certain preparations that are required before and after the procedure has finished.

Are there any risks of Lumbar discography?

Although in most cases, Lumbar discography is considered to be a rather safe procedure when it is performed with sterile technique by an experienced doctor, there are some risks that you need to discuss with your doctor before you agree to this procedure. In the following, we will list the most common risks and complications that may occur as a result of the Lumbar discography.

• Infection
• headache
• Worsening of the low back pain
• Allergic reaction to the contrast
• Injury to the nerves around the spine
• Injury to the blood vessels around the spine

Conclusion

Lumbar discography is a highly effective and safe procedure when it is performed under proper circumstances and with the experience and knowledge of a professional spine specialist. Lumbar discography is used to help diagnose degenerative disc causes of lower back pain and will help guide treatment protocols.

Treatment options for lower back pain is best achieved through a combination of injection in conjunction with graded rehabilitative exercise. Individual programs may include a cortisone shot, regenerative medicine, PRP injection, PRP treatment or stem cell therapy which boosts the body’s natural ability to heal.

If your pain does not resolve after a brief period, so that we may help diagnose the problem and treat the underlying cause. Do not let pain persist or else it may become chronic.

^[1] Waxenbaum JA, Futterman B, (August 2018), Anatomy, back, lumbar vertebrae, StatPearls (Internet)
https://www.ncbi.nlm.nih.gov/books/NBK459278/

^[1] Provenzano DA, (February 2012), Diagnostic discography: what is the clinical utility? Current Pain and Headache Report 16(1):26-34. doi: 10.1007/s11916-011-0239-6
https://www.ncbi.nlm.nih.gov/pubmed/22147277