Lumbar provocative discography
Encyclopedia
Lumbar provocative discography (also referred to as "discography" or discogram) is an invasive diagnostic procedure for evaluation for intervertebral disc
pathology. It is usually reserved for persons with persistent, severe low back pain
(LBP) who have abnormal spaces between vertabra on magnetic resonance imaging
(MRI), where other diagnostic tests have failed to reveal clear confirmation of a suspected disc as the source of pain, and surgical intervention is being considered.
Needles are inserted through the back into the disc
near the suspect area, guided by fluoroscope imaging. Fluid is then injected to pressurise the disc, any pain responses are recorded.
This is repeated in random order for the various discs, without the patient knowing which disc is pressurised. This can be used to detect patients who may be exaggerating their symptoms, or to assess their pain response and hence their suitability for recovery from possible surgery (often a Discectomy
).
A contrast agent
is introduced, and after the procedure a CT scan identifies leakage from the discs to identify any spinal disc herniation
.
Possible complications include discitis
, an infection of the disc. Strong antibiotics are usually administered as a precaution.
Intervertebral disc
Intervertebral discs lie between adjacent vertebrae in the spine. Each disc forms a cartilaginous joint to allow slight movement of the vertebrae, and acts as a ligament to hold the vertebrae together.-Structure:...
pathology. It is usually reserved for persons with persistent, severe low back pain
Low back pain
Low back pain or lumbago is a common musculoskeletal disorder affecting 80% of people at some point in their lives. In the United States it is the most common cause of job-related disability, a leading contributor to missed work, and the second most common neurological ailment — only headache is...
(LBP) who have abnormal spaces between vertabra on magnetic resonance imaging
Magnetic resonance imaging
Magnetic resonance imaging , nuclear magnetic resonance imaging , or magnetic resonance tomography is a medical imaging technique used in radiology to visualize detailed internal structures...
(MRI), where other diagnostic tests have failed to reveal clear confirmation of a suspected disc as the source of pain, and surgical intervention is being considered.
Needles are inserted through the back into the disc
Intervertebral disc
Intervertebral discs lie between adjacent vertebrae in the spine. Each disc forms a cartilaginous joint to allow slight movement of the vertebrae, and acts as a ligament to hold the vertebrae together.-Structure:...
near the suspect area, guided by fluoroscope imaging. Fluid is then injected to pressurise the disc, any pain responses are recorded.
This is repeated in random order for the various discs, without the patient knowing which disc is pressurised. This can be used to detect patients who may be exaggerating their symptoms, or to assess their pain response and hence their suitability for recovery from possible surgery (often a Discectomy
Discectomy
A Discectomy is the surgical removal of herniated disc material that presses on a nerve root or the spinal cord. The procedure involves removing the central portion of an intervertebral disc, the nucleus pulposus, which causes pain by stressing the spinal cord or radiating nerves...
).
A contrast agent
Contrast medium
A medical contrast medium is a substance used to enhance the contrast of structures or fluids within the body in medical imaging...
is introduced, and after the procedure a CT scan identifies leakage from the discs to identify any spinal disc herniation
Spinal disc herniation
A spinal disc herniation , informally and misleadingly called a "slipped disc", is a medical condition affecting the spine due to trauma, lifting injuries, or idiopathic, in which a tear in the outer, fibrous ring of an intervertebral disc allows the soft, central portion A spinal disc herniation...
.
Possible complications include discitis
Discitis
Discitis or diskitis is an infection in the intervertebral disc space that affects different age groups, but usually spontaneously affects children under 8 years of age. Nonetheless, discitis occurs post surgically in approximately 1-2 percent of patients status post spine surgery.-Signs and...
, an infection of the disc. Strong antibiotics are usually administered as a precaution.