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Discography

Published by Bupa's health information team, July 2009.

This factsheet is for people who are planning to have discography, or who would like information about it.

Discography is a test which uses a special dye (contrast medium) and X-rays to look at the spine and highlight any discs that are causing pain.

Your care will be adapted to meet your individual needs and may differ from what is described here. It's important that you follow your doctor's advice.

About discography

The spine is made up of bones called vertebrae. They are separated by strong connectors called discs, which are made up of cartilage. The discs act as shock absorbers and allow the spine to bend. Your spine is supported along its length by muscles and ligaments. Your spinal cord threads down through the middle of each vertebra, carrying nerves from your brain to the rest of your body.

Illustration of the different parts of the spine
The different parts of the spine

Your discs can become worn and either bulge out from between the vertebrae or burst and leak fluid. This condition is commonly known as a herniated disc. Some herniated discs put pressure on the nerves and can cause pain or numbness in the legs.

The aim of discography is to identify which disc, if any, is causing your back or leg pain. Discography involves injecting a special dye (contrast medium) that shows up on an X-ray into the discs of the spine. If a disc isn't damaged, the dye will stay in the centre of the disc only. However, if the disc is damaged, the dye will spread through the disc, or leak out of the disc.

Discography is still a controversial procedure because of differing evidence available on how effective it is. It's usually only done if simple measures have failed to control your pain. Discography can help your doctor to plan surgery or other appropriate interventions for treating your pain.

What are the alternatives?

You should discuss the risks and benefits of discography with your doctor. Your doctor may decide it is better for you to have a magnetic resonance imaging (MRI) scan. An MRI scan uses magnets and radiowaves to produce images of the spine. Because it doesn't use X-rays you won't be exposed to any radiation. However, MRI scans aren't able to show whether or not a disc is causing pain.

Preparing for your procedure

You may be asked not to take your usual pain relief medication on the day of your procedure. This is because you may need to feel and report any pain you feel during the test.

Discography is routinely done as an out-patient or day-case procedure with or without sedation. Sedative drugs relieve anxiety and help you relax without putting you to sleep. You may also be given a local anaesthetic to numb the skin on your back.

You may need to fast before your discography. Follow the instructions given to you by your doctor.

At the hospital your nurse may check your heart rate and blood pressure, and test your urine.

Your doctor or another health professional will usually ask you to sign a consent form. This confirms that you understand the risks, benefits and possible alternatives to the procedure and have given your permission for it to go ahead.

About the procedure

Discography takes between 30 and 45 minutes to complete and is usually done in the X-ray department or operating theatre. It's carried out by a doctor who specialises in using imaging methods to diagnose back pain.

You will have a small plastic tube (cannula) placed in a vein in the back of your hand. This can be used to give you sedatives, or other medicines if necessary, during your treatment. Sedation will make you feel relaxed. You have to be awake during the procedure so you can tell your doctor the location and type of pain you have during the injection. You may also be given a dose of antibiotics via this tube to help prevent infection.

You will lie on your side or your front on an X-ray table, and your skin will be cleaned with a sterile antiseptic wipe. Local anaesthetic will be injected into the skin so that you don't feel the needles going into your skin.

A thin hollow needle will be carefully inserted into your back, up to the edge of the disc. A thinner needle will then be passed through the first needle into the centre of the disc. More than one disc may be investigated at once so this may be repeated several times. During the procedure, your doctor will take X-rays to ensure that each needle is correctly placed.

The procedure can be uncomfortable because the needles may be inserted in an area that is already painful. If you feel any pain in your legs whilst the needle is being inserted, please tell your doctor immediately.

A special dye (contrast medium) that is visible on an X-ray will be injected into the centre of each disc and X-rays taken. If the X-rays show the dye staying in the centre of the disc only, then it's normal. However, if the dye spreads out through the disc, or leaks from the disc, then it's damaged. While this is being done, you will be asked to rate any pain or pressure you feel on a scale of zero to 10. You will also be asked where you feel the pain and whether or not it is similar to your usual pain.

At the end of the test the needles are removed. The injection site will be covered with a plaster. You may also have a CT scan so that your doctor can see if the contrast has spread further.

What to expect afterwards

You will be kept under observation for around 30 minutes. When you feel ready, you will be able to go home. You will need to arrange for someone to drive you home. You may have increased pain for a few hours after discography. In rare situations, you may have increased pain for a couple of days.

Your nurse will give you some advice about caring for your healing wounds before you go home. You may be given a date for a follow-up appointment.

Your doctor will review your test results and explain them to you at your follow-up meeting. The test will hopefully give a better understanding of your back problem and your doctor will offer suitable advice and treatment.

Recovering from discography

Sedation temporarily affects your coordination and reasoning skills, so you must not drive, drink alcohol, operate machinery or sign legal documents for 24 hours afterwards. If you're in any doubt about driving, please contact your motor insurer so that you're aware of their recommendations, and always follow your doctor's advice.

It's sensible to take it easy for the rest of the day. You must follow your doctor's advice about returning to work and resuming normal activities. Please contact the hospital or your GP immediately if you:

  • feel unwell
  • develop back pain that continues to get worse over several days
  • develop a fever or a high temperature

What are the risks?

In order to make an informed decision and give your consent for discography, you need to be aware of the possible side-effects and the risk of complications of this procedure.

Discography often includes both X-rays and a computed tomography (CT) scan. A CT scan uses X-rays to make a three-dimensional image of the spine. X-rays and CT scans expose you to some radiation. The amount of radiation you will be exposed to will depend on the number of X-rays you need and whether or not you have a CT scan.

If you're pregnant

Although the radiation dose used is generally thought to be safe for adults, it may harm a developing fetus. If you think you are or could be pregnant, tell your doctor before your discography appointment.

Side-effects

These are the unwanted but mostly temporary effects of a successful procedure.

After the test, you may have some bruising, swelling and pain at the injection site. If you need pain relief you can take the painkiller you would normally take for a headache. Always read the patient information leaflet that comes with your medicine and if you have any questions, ask your pharmacist for advice.

Complications

This is when problems occur during or after the procedure. Most people aren't affected.

Complications of discography are rare but can be serious, these include the following.

  • Disc infection. The symptoms are intense pain and a fever. You will usually be given antibiotics before the test to help prevent infection.
  • Inflammation of the nerves in your spine, damage to nerves or tendons and bleeding into the spinal cord near the discs being injected.
  • Headaches, seizures and nausea.
  • An increase in your back or leg pain.

The exact risks are specific to you and differ for every person, so we have not included statistics here. Ask your doctor to explain how these risks apply to you.

Related topics

Further information

Sources

  • Useful definitions & glossary. British Pain Society. www.britishpainsociety.org, accessed 29 January 2009
  • Glossary. Brain and Spine Foundation. www.brainandspine.org.uk, accessed 29 January 2009
  • Dandy DJ and Edwards DJ. Essential orthopaedics and trauma 3rd ed. Oxford: Churchill Livingstone, 1998:55
  • MacPherson G. Black's medical dictionary. 39 ed. London: A & C Black, 1999:507-9
  • Standring S. Gray's anatomy. Oxford: Churchill Livingstone, 2008:712-3
  • About your back. BackCare. www.backcare.org.uk, accessed 29 January 2009
  • Bull E and Archard G. A simple guide to back pain. Long Hanborough: CSF Medical Communications Ltd, 2005:4-5
  • Discography. eMedicine. www.emedicine.com, accessed 29 January 2009
  • Discography. North American Spine Society. www.spine.org, accessed 29 January 2009
  • Information for patients having an MRI scan. Royal College of Radiologists. www.rcr.ac.uk, accessed 2 February 2009
  • Anaesthesia explained. Royal College of Anaesthetists. www.rcoa.ac.uk, accessed 29 January 2009
  • Good practice in consent implementation guide: consent to examination or treatment. Department of Health, 2001. www.dh.gov.uk
  • Information for patients having an X-ray. Royal College of Radiologists. www.rcr.ac.uk, accessed 2 February 2009

This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.

Publication date: July 2009

 

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