FAQs Regarding Lumbar Discogram
What is a Lumbar Discogram?
A discogram of the lumbar spine, also called lumbar discography, is a pain management procedure that serves a valuable diagnostic purpose. It can help a pain doctor, orthopedic spine surgeon or neurosurgeon determine whether or not one of a patient’s intervertebral discs is the source of an individual’s back pain. It is an outpatient procedure that takes 30 to 60 minutes.
What is the purpose of a discogram?
Right away, it should be understood that a lumbar discogram does not have a therapeutic purpose. It is not a procedure designed to administer pain relief. It is simply a diagnostic tool for pain doctors to determine whether or not a spinal disc is the source of back pain.
How is a discogram performed?
These procedures are performed either in a procedure room or an outpatient surgery center setting. Patients are given intravenous sedation, but cannot be completely “knocked out” for the procedure as patient input is necessary.
The pain management doctor in Los Angeles will use fluoroscopy for the procedure, which is a real time x-ray machine. This way, the highest accuracy can be obtained with the needle placement into the disc space.
The skin and soft tissues down to the disc area are numbed up, and the catheter is placed into the intervertebral disc being evaluated.
Usually, one or two discs are evaluated as a source of pain, and a third disc is used as a control level. This would be a level that looks normal on MRI and does not appear to be the source of any pain for the patient.
Once the catheters are in place in the spinal discs being tested, one at a time fluid is injected into the disk space. This fluid contains contrast, which allows the fluid to show up
on the x-ray.
There is considerable debate over how much pressure to inject the fluid under. The patient is asked whether or not the back pain he or she experiences on a daily basis is reproduced by the fluid insertion.
Once each level of testing is completed, patients will typically be sent for a CAT scan to look at the competency of the disc. In addition, the CAT scan will also show how much arthritis is present in the facet joints at the spinal levels being tested.
Is a discogram painful?
Unfortunately, the answer is yes. It is not a therapeutic study. It is designed to reproduce the pain the patient experiences on a daily basis. Once the study is complete, the pain doctor typically injects numbing medicine into the disc which will last for 12 hours or so. By and large though, most patients do experience significant discomfort during the discogram.
What is a positive test?
If the level being tested reproduces the back pain the patient experiences on a daily basis, that is considered a positive level. If the level being tested causes considerable pain which is different than what the patient experiences on a daily basis, then that is not a positive level. And if the test at a particular level sparks up no pain, that is also a negative level.
How accurate is a lumbar discogram?
This has been a heavily debated topic for over two decades. For every study that shows discograms work well for diagnostic purposes, there is another study that shows it is not a useful study.
There have been large studies, small studies, meta-analyses and expert opinions on both sides of the fence with discogram. Some pain doctors and surgeons view it as an integral test in deciding whether not the disc is a pain generator, while others view it as completely inaccurate.
What are the risks of a discogram?
The risks of these studies are exceptionally small. There is a minor risk of infection, nerve injury or bleeding. If the patient is on blood thinners, those should be stopped 5 to 7 days prior to the study. Talk to your Los Angeles pain clinic doctor about the specific timeframe.
There have been some small studies showing potential disc degeneration from the discogram study, but this has not been shown definitively.
What’s the bottom line on lumbar discograms?
When pain management doctors in Los Angeles are looking to delineate whether or not a particular lumbar disc is the source of the patients pain, there are only so many tools available to help with the diagnosis.
History and physical exam along with x-rays, MRI and other studies can help to a certain extent. It is well-known that degenerative disc disease on an MRI is very common even in those who have no evidence of low back pain.
Therefore, it is a reasonable test in the spectrum of diagnostic tools available to help in the diagnosis of degenerative disc disease, and whether or not it is contributing to a particular patient’s chronic back pain.
If you are experiencing chronic back pain in the greater Los Angeles area, let the California Pain Network help you. The Network includes the best pain management Los Angeles has to offer including Board Certified pain doctors along with chiropractic doctors, spinal decompression therapy and more. Simply fill out the contact form on the page or call (310) 626-1526 today!