My name is Scott Farley, I am an orthopedic spine surgeon and today I would like to talk to you about a discogram. In this case we are going to talk about a lumbar discogram. The purpose of a lumbar discogram is to give information about the health of the lumbar disc. Who this procedure is useful for is trying to find out if the disc in the lower lumbar area is the source, or the major source of a patient’s pain. And if it may or may not be beneficial to perform a lumbar fusion on a patient.
So, the idea is, is that when you, the patient is walking, gravity, the disc that you can see between the bone and the disc and the bone, is good in compression meaning as a shock absorber. And it doesn’t have a tough time in sheer, forces going across the disc area. The disc area can become degenerative, meaning wearing in time. The disc can be traumatically injured, so that the back fibers or the anulus, the outer fibers of the disc, on this portion of the disc, can be injured causing pain. So, if the disc has discoloration or dehydration on an MRI, on a T2 sequence, would look like a very dark disc. If we operated on, in my practice, all patients who simply had a dark disc, we would do a lot of needless surgery for patients, and patients wouldn’t get better. As a spine surgeon I only want to do surgery on those patients where it is appropriate. I want to treat patients like they are family members of mine and only do procedures, such as a spinal fusion, when I believe the benefits significantly outweigh the risks. For some patients, as they have tried all treatment modalities, conservative options, pain management injection procedures, and are still having significant pain, and that there is corroborating, or information from the MRI that would show a significantly altered or damaged disc. For these patients, I will talk to many of patients about performing a discogram. The discogram is added information. A discogram is not the only bit of information that would be used to decide if surgery is required, it’s a very helpful adjunct to the other MRIs, X-Rays, and history of a patient.
So, to give you an idea of what the procedure entails, is a patient in a procedure room would be, have an IV place and be twilighted, be basically asleep but conscious and breathing and controlling their own airway. A patient would be laying on their stomach and the pain doctor would be introducing a needle into the area of the disc that looks abnormal. In this case we’ll say it would be the L5, S1 disc is abnormal. The needle would be placed into the L5, S1 disc and then a needle would be placed into a control or a normal disc at L4, L5. Then with the needle in place, which would be guided with an x-ray machine, a pressure transducer is placed, and so a transducer such as this would be placed on the needle, and then through the transducer, dye would be placed into the actual disc. What the dye, what we would expect in the control level, is it would produce very little pain in the patient who is asleep. They would be conscious to say that is not my normal or my home pain.
So, it gives information about the patient’s pain response to the pressure. It gives information about how the dye is able to collect in the disc, and it also give a visual appearance of how the dye is distributed in the disc.
Now again, the discogram is a procedure that is an adjunct to every other portion of a patients care. All of their MRIs, all of their x-rays, their flexion-extension x-rays, and helps with the possibility of determining if surgery is required or not required. In my training, when I was a resident in my practice, this is an excellent procedure to gain information about you the patient. I find it a valuable tool to help you guide your care.