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Thomas Schuler, MD, FACS, FAAOS

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Discography: A Diagnostic Procedure For Locating Your Pain

Authored by Thomas Schuler, MD, FACS, FAAOS. September 5, 2019

You’ve lived with a long history of back pain, and recently have been diagnosed with a spinal condition. In order for a spine specialist to determine the optimal treatment plan for you, they’ll need to identify the source of your pain. An effective way of doing this is by performing a discography.

What is a Discography?

An MRI may show us degenerative discs and herniations, but it does not tell us where the back pain is coming from. A discography, or discogram, is a test where the physician places a needle into the disc and injects dye to see if there is any leakage, which indicates a tear in the disc. The pressure from the dye can reproduce the symptoms confirming the location of the patient’s discomfort. Normal appearing disc levels are also tested as a control to confirm these are not contributing to the patient’s symptoms.

How Can You Identify Where My Back Pain is Coming From?

The MRI lets us look at the disc and see if it is abnormal, but the discography lets us figuratively ask, ‘Does this hurt when I poke it?’ Palpation, or touch, is the most important part of a clinical exam of the spine in order to find the source of pain. However, there is no way for us to palpate a disc with our clinical exam. The discography is a way for us to do that with a test.

Anatomy of a Disc:

The disc themselves do not have nerves on the inside, but nerves are present on the outer edge (annulus). Normally a disc does not hurt, but the pain receptors of the nerves get stimulated as the disc gets tears and is disrupted. As the disc breaks down, produced enzymes become very irritating to the nerves. This is why people with chronic pain often have disc abnormalities as a source of the pain.

How is a Discography Performed?

For this procedure, dye is injected into the center of the discs and is clearly visible using an x-ray machine. A healthy disc should allow dye to enter the disc and should not cause any pain. If a disc has a tear or rupture, the pressure from the dye will irritate the pain receptors. This will cause the patient’s pain to be reproduced, and dye will be seen leaving the disc space.

Other than reproducing the patient’s symptoms, the volume of dye that the disc is able to hold during a discography allows the physician to determine the structural competence, or incompetence, of that disc. Where as the amount of dye injected can tell us how worn out the disc is becoming. All of this information helps us determine the appropriate way to treat the disc.

Treatment Options for an Unhealthy Disc:

For a degenerative disc, taking bone marrow concentrate and stem cells from the pelvis and injecting it into the disc, may be a way to treat it. Other treatments may require a spinal fusion to solve the problem. The use of discography allows the physician to identify the source of pain, which then helps develop the optimal treatment plan for each patient. The goal is not to treat every degenerative disc, but treat the ones that are causing the pain.

At Virginia Spine Institute, our unique belief is to treat our patients with the most comprehensive care possible. Our team will coordinate an individualized, comprehensive treatment plan to restore you to a full and active lifestyle.

About The Authors

Thomas Schuler, MD, FACS, FAAOS

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