Discogram (Discography)

What is a discogram procedure?

A discogram (also called discography) is a type of imaging test that helps diagnose chronic (long-term) back pain. It may be able to tell your healthcare provider whether your symptoms result from a worn or damaged spinal disk.

You have disks between every vertebrae — the bones that make up your spine. The disks are like spongy cushions that absorb shock and keep your spinal bones from rubbing against each other. Damaged disks are a common cause of chronic (long-term) back pain.

Healthcare providers usually prefer other imaging tests — like CT (computed tomography) scans or MRI (magnetic resonance imaging) — to diagnose back pain. But they might need to take a discogram if:

• They need more information to make a diagnosis.
• You still have back pain after trying conservative treatments like medication and physical therapy.

Surgeons may also use discograms before spinal fusion surgery to confirm which disks need to be removed.

You might hear healthcare providers refer to cervical or lumbar discograms. These terms refer to the same procedure but specify which section of your spine needs imaging. If you have neck or upper back pain, you’ll need a cervical discogram. If you have lower back pain, you’ll need a lumbar discogram.

It’s important to note that damaged spinal disks don’t always cause back pain. For this reason, discograms are controversial in the medical community. But many healthcare providers believe that a discogram can help confirm suspected findings on a CT or MRI scan.

How does a discogram work?

A discogram uses fluoroscopy to see how your vertebrae and spinal disks move. Fluoroscopy produces a moving X-ray image — a video you can watch in real time.

Your provider will also inject a contrast material (dye) into each disk to highlight potential areas of concern. If the contrast stays contained inside of your disk, it’s healthy. If the contrast spreads beyond the outer border of your disk, the disk might be worn or torn.

How do I prepare?

Your healthcare provider will give you instructions to follow before your discogram procedure. In general, you should:

• Tell your healthcare provider about any medications you’re taking — including over-the-counter medications and supplements — and inform them of any known allergies.
• Let your provider know if you’re pregnant or think you might be.
• Arrange for a friend or family member to drive you to and from your appointment. (You’ll likely be sedated for the procedure and won’t be able to drive yourself home.)

What to expect during a discogram

When you arrive for your appointment, a provider will take you to an X-ray room where you’ll lie on an exam table. They’ll position you on your side and place pillows to keep you comfortable.

Most providers use IV (intravenous) sedation during a discogram. They’ll place an IV in a vein (usually in your arm or hand) and give you sedative medications to help you relax. They’ll also monitor your oxygen, blood pressure and heart rate throughout the procedure.

Once you’re comfortable, your provider will:

1. Give you local anesthesia to numb a small area on your back.
2. Insert a needle through your skin and into a spinal disk using X-ray (fluoroscopy) guidance.
3. Inject the contrast material into your spinal disk and remove the needle. (If the disk has damage, you may feel back pain similar to what you routinely experience. During this step, your provider may ask you to describe the pain and where it hurts.)
4. Repeat steps one through three on other disks, if necessary.
5. Place a bandage over the injection sites to stop any bleeding.

Your provider will use fluoroscopy to take images during the discogram procedure. Afterward, they may also take a CT scan or an MRI. Using more than one imaging test can help your provider make an accurate diagnosis.

From start to finish, a discogram usually takes about one hour.

What to expect after the procedure

The area near the injection sites might feel tender or uncomfortable for several hours after your discogram. You can manage this pain with at-home icing. Wrap an ice pack in a towel and place it over the sore areas for 20 minutes, then remove it for 20 minutes. Repeat as often as necessary. You can also take pain relievers like acetaminophen (Tylenol®) or ibuprofen (Motrin®).

Are there risks?

Discogram complications are rare, but could include:

• Infection.
• Bleeding.
• Back pain that gets worse before it gets better.
• Blood vessel or nerve damage.
• Temporary weakness or numbness.
• Headaches.
• Nausea.
• Allergic reaction to the contrast material.
• Paralysis.

What is the recovery time for a discogram?

Most people can comfortably return to work, school and other routine activities after 24 hours. But it might take a few days for the soreness to go away.

What do my results mean?

A radiologist will read the results of your discogram to see if the contrast material stays inside each disk or if it leaks out.

If it stays inside your disk, that’s a normal (negative) result. If it leaks outside your disk, it indicates wear-and-tear damage (positive result).

When should I know the results of my discogram?

Once your radiologist reviews your discogram, they’ll send the results to your provider. Once they have the results, your provider will discuss them with you. Most people get their results within a week.

If the results are abnormal what are the next steps?

It depends on your situation. Your provider may want to take additional imaging tests before deciding on a treatment plan. Or they may recommend spinal fusion — a procedure to remove the affected disk and fuse the vertebrae to reduce back pain symptoms.

When should I call my healthcare provider?

After your discogram, call your healthcare provider if you develop:

• A fever over 101 degrees Fahrenheit (38.3 degrees Celsius).
• Discoloration, swelling, warmth or discharge at the injection site.
• New back pain.
• Back pain that gets worse.

How painful is a discogram?

If you have a damaged spinal disk, you’ll probably feel some pain when your provider injects the contrast material into it. Most people report the pain is very similar to the symptoms they experience every day. While temporarily unpleasant, this sensation can help your provider pinpoint which disks have wear and tear.

You may also have lingering discomfort for a few days. If this happens, take over-the-counter pain relievers and ice the area a few times each day.

What’s the difference between a discogram and an MRI?

Both are imaging tests providers use to help diagnose back pain, but they differ in a few ways:

It’s common for healthcare providers to take CT scans or MRI scans first. If they need more information after trying other imaging tests, they may request a discogram.