Treatments
5. Lumbar Discography
Objective: Discography is not a treatment to reduce pain, but a diagnostic tool to replicate your normal pain and determine a) whether spinal pain is caused by annular tears, and b) diagnose how many disks are affected. (Annular tears are tears in the outside lining of the disk, which enable nerves to grow into the spongy, shock-absorbing part of the disk. These tears are usually caused by disk degeneration or trauma.) Since not all annular tears seen on an MRI cause pain, discography is the only way to locate pain-producing disks. This test helps us choose options for further treatment. Symptoms: Severe back pain triggered by movement (due to compression of the new nerves that have grown into the disk).
Pre-Treatment: If any sedatives are to be administered, do not eat/drink after midnight on the day of the procedure, unless otherwise instructed. Do take all other usual medications (except for those mentioned below) with small amounts of water on the day of the procedure. Driver needed? Yes. Moreover, driver must stay in our lobby during the entire time you are in our facility. Medications: 7 days before the procedure, stop Plavix. 14 days before, stop Ticlid (ticlopidine). 4 days before, stop Coumadin/Warfarin.
Treatment: Depending on the central situation, we may administer mild intravenous sedation prior to treatment. Then, we use x-rays to guide the placement of needles into the disks of the spine. Next, we inject each disk with iodine, to show contrast under fluoroscope x-ray. We evaluate the contrast pattern in the x-ray images. We also question you on the location, severity, and character of pain produced during the injection, compared to your normal, everyday pain. An antibiotic is also injected. After the injection is complete, the needles are removed. If needed, a CT scan may also be performed shortly after the discography.
Pain Associated with Treatment: This procedure isn’t designed to reduce pain. During the injection, a second type of pain (due to the needles themselves) is usually felt to the right or left of the spine depending on the location of the needles. Otherwise, pain is minimal. Rate of Complications: Rare. These may include bleeding, infection of the disk space, nerve injury, spinal cord injury, spinal headache, abscess or blood clots, and paralysis, and should be discussed with your physician prior to the procedure.
Discharge Instructions: Try to rest as much as possible the first several days after the procedure. You can resume your normal diet and medications immediately, unless otherwise instructed. If we place Band-Aids over the injection site, remove the next day. If we prescribe you a narcotic pain medication, note that it may require 45 minutes to reach its peak effect, and may cause dizziness or drowsiness.
Side Effects: Flare-ups lasting up to a week or more are normal. In rare instances, the injected antibiotic and iodine dye may result in difficulty breathing, rash, or severe dizziness. There is a possibility of a spinal fluid leak with spinal headache (severe pain on sitting or standing that significantly lessens when lying down), especially if the needle approach to the disk is impossible due to bone spurs in your spine.
If you experience discomfort at the injection site, apply ice wrapped in a washcloth for short periods of time (20 minutes per hour) during the first 24 hours, then apply low to medium heat. There may be soreness and bruising around the IV site, which will go away in a few days. A warm moist cloth placed over the area for half-hour periods several times a day may help.
Anesthetic Effects: If sedation is given, refrain from operating motor vehicles within the first 12 hours after the injection and do not plan to make any important decisions such as signing legal papers within the first 24 hours after the injection. Do not consume alcohol within 12 hours after the injection.
Notify Us Immediately If: 1. You experience increased tenderness or red streaking around the area of the IV site, or increasing swelling of the hand. 2. You experience temporary numbness in one leg. 3. There is any new loss of bladder or bowel control (excessive and uncontrollable amounts), new numbness or weakness, or fever of more than 101 with severe worsening back pain.