Provocative discography is a diagnostic tool that is used in patients with mostly axial back pain. If they have a positive
response to the procedure, they might be a candidate for surgical fusion, or minimally invasive procedures such as IDET
(Please refer to Procedures page).
The discs are soft, cushion-like pads which separate the hard vertebral bones of the spine. A disc may be painful when it
bulges, herniates, tears, or degenerates and may cause pain the neck, mid-back, low back and arms, chest wall, abdomen, or
legs. Other structures in the spine may also cause similar pain such as the muscles, joints, and nerves. Before performing
discography, it has usually been determined that these other structures are not the sole source of pain in a patient (through
history and physical examination, review of x-rays, CTs, MRIs and/or diagnostic injection procedures such as facet injections,
sacroiliac joint injections, and/or nerve root blocks).
An IV and antibiotic infusion will be started prior to the procedure. The patient will be placed in prone (face down) position and
using live X-ray the target disc levels will be identified. This will involve the level(s) that based on the MRI and the patient’s
symptoms might be responsible for the pain, in addition to an unaffected level as control. After numbing the skin overlying
these areas, the needles will be directed inside the discs under fluoroscopic guidance. At this time the physician will inject
contrast solution in the disk. This step will not only pressurize the disc space, but it will also show the morphology (shape) of
the disc. By asking the patient questions about the quality and location of pain, the physician will determine the pathological
disc.
A positive test is experience of pain similar to the usual symptoms the patient experiences on a regular daily basis.
The procedure will take 30-45 minutes. Since this a provocative diagnostic test, the patient symptoms might transiently be
exacerbated after the procedure. Band-Aids will be placed at the injection sites, and a nurse will monitor the blood pressure
and pulse and will review the discharge instructions with the patient before going home.
