This included individuals without low-back pain but who had significant emotional and chronic pain problems. Discogram is another term for discography. Surgery was a success my left knee is fully functional again. Discography is typically reserved for patients who have been unable to find relief from other diagnostic methods or first-line treatment approaches. The doctor will then use x-ray imaging to insert needles filled with medical dye into the discs. This injection is guided by a Fluoroscopy machine. As each disc is injected, you may be asked to rate the intensity of the pain that the injection causes, if any.
Our conclusion is that discography is a low risk procedure for a properly selected patient. Elastin fibers lie between the lamellae, assisting the discs as they return to their original arrangement following flexion or extension. On the other hand, painful discs with negative imaging findings are considered inconclusive and repeating the test is recommended. This study questions the ability of a patient to separate concordant pain on discography from other non-spinal pain. It is an invasive procedure performed using fluoroscopic guidance real-time x-ray for precise needle placement. If you experience intense pain, call your health care provider.
These changes are often followed by intraradicular fibrosis and neural atrophy. Not all degenerative discs are the source of pain. The procedure is repeated at all the levels to be tested. The doctor will then place a small needle into the center of each disc and inject some radio-opaque dye. The herniated disc and resulting inflammatory factors stimulate nocioceptors in the posterolateral annulus, the ligamentum flavum, and the posterior longitudinal ligament, resulting in pain. It is a relatively simple procedure that uses a small needle to inject contrast dye into your disc. Your health care provider who referred you for the procedure will go over the results of this test and discuss possible options for treatment.
The nucleus pulposus of the disc contains a lot of water, which lets it bear weight and transfer load much like pressing on a water balloon. After the disc injections, you may be kept for observation for 30 minutes or more. A normal disc accepts the injection of contrast without pain, usually maintains a high internal pressure with the injection, and demonstrates no leak of contrast from the central portion of the disc. What are the risks of this test? The flow of dye in the disc is visualized under x-ray to determine if the patient has disc tears or disruptions. While Holt addressed a central issue in the discography debate, other studies in 1968 evaluated discography and showed the positives of the procedure.
The carotid pulse is palpated. Pain into the extremity likely suggests contact with the nerve root, at which point the needle is redirected. Carragee has also questioned the validity of provocative discographic results irrespective of physiological overlay. The thoracic region is less mobile due to its connections with the rib cage. Plavix ® and Aggrenox ® are stopped 1 week prior to the procedure to avoid bleeding. This test is done under fluoroscope and the patient has a mild sedative medication along with local anesthesia to make the patient as comfortable as possible.
By injecting a contrast dye into the disc, the physician can see any abnormalities or tears in the disc itself. If pain is provoked at a pressure less than 15 psi 103. The anterior portion of the vertebra consists of the vertebral body. You may also be asked if the pain is similar to your usual symptoms in terms of location and the type of pain you are experiencing. It is made of a central portion the nucleus pulposus which is surrounded by layers of tissue the annulus fibrosis.
The nucleus pulposus sits between the cartilage end plates. They have the same morphology as nociceptive nerve terminals. Any deviation leads to the risk of annular injection of contrast. Supporters for the use of discography counter these points through a number of studies. This is needed to confirm contrast injection into the nucleus pulposus.
These studies may be measuring the efficacy of spinal fusion and not the predictability of discography. In a normal disc, there are nerves only in the outermost layers of the annulus fibrosis. Doctors may administer intravenous sedation to make patients more comfortable. Do I ever have to have a discogram done again? Needle placement Thoracic discography is performed in a similar fashion as lumbar discography with a few changes due to anatomical considerations. Insertion of Guide Needles Once anesthesia has been applied, your doctor will use the X-ray images provided by the fluoroscopic table to carefully insert a guide needle through to the annulus fibrosus, the outer layer of the disc to be tested. The injection has a mixture of x-ray contrast and antibiotics. The patient is asked about any sensations felt upon the injection.