Discography

A Discography is used for chronic deep back pain that allows conclusions to be drawn about discogenic (intervertebral disk-related) causes. Under X-ray control, degenerative changes in the intervertebral disc are made visible with the help of a contrast agent.

What is discography?

As Discography (also known as discography) is an X-ray-based diagnostic method for the representation of intervertebral discs (disc or discus intervertebralis) using an intradiscally injected contrast medium.

With the help of the method, the origin of disc-related back problems (discogenic pain syndrome, discopathy) can be precisely localized using the radiographically documented contrast agent distribution and degenerative or age-related changes in the affected disc can be determined. As a result of degenerative processes on the intervertebral disc, painful fissures (cracks) on the outer fiber ring of the intervertebral disc and / or disc protrusions (intervertebral disc protrusions) can develop.

In most cases, the lumbar spine is affected by such internal disc architecture injuries. As the nerve fibers grow into the disc structures, pain radiates from inside the disc. Morning back pain caused by lying down for a long time, as well as pain when the back is overloaded, can be signs of disc degeneration and require a discography.

Function, effect & goals

A Discography is often used in the run-up to minimally invasive surgical interventions on the spine (intervertebral disc prosthesis, spondylodesis) for planning and diagnosis confirmation. The examination procedure is used to precisely determine the vertebral segments to be operated on.

In addition, the information obtained through a discography can facilitate and support the choice of therapy for chronic deep-seated back pain (including intradiscal electrothermal therapy or surgery) that can be attributed to pathological disc changes. The minimally invasive examination can be carried out under inpatient or outpatient conditions, whereby anesthesia is not necessary or even undesirable.

With the patient lying on their stomach and in twilight sleep, a probe or thin needle (cannula) is inserted laterally into the intervertebral disc space (space between two adjoining vertebral bodies in which the intervertebral disc is located) under local anesthesia. Then a radiopaque contrast agent - in the case of a contrast agent allergy, saline solution - is injected into the jelly-like nucleus of the disc (nucleus pulposus). The course of the contrast medium is made visible in several planes by a movable X-ray device (image converter).

On the one hand, the correct positioning of the probe or cannula is checked on the basis of the contrast agent distribution in the intervertebral disc nucleus and, on the other hand, an assessment of the condition of the intervertebral disc and the extent and type of degenerative changes is made possible. If, for example, there is an intact fibrous ring surrounding the intervertebral disc (annulus fibrosus), the contrast agent remains in the intervertebral disc, while leakage of the agent from the intervertebral disc space suggests a porous or torn annulus fibrosus as a result of a herniated disc.

A ring of fibers protruding back into the spinal canal (spinal canal), which can lead to pain symptoms in the back and legs due to the compression of one or more nerve roots, can also be made visible in a discography. The fact that the otherwise usual pain can also be provoked or intensified by the administration of contrast medium via the pressure increase in the disc (discographic distension test) is an additional significant effect (so-called memory pain effect), which supports the localization of the spinal column segment affected by degenerative processes.

With a subsequent injection of an anesthetic that eliminates this pain, the diagnosis can also be confirmed. After the discography, an anti-inflammatory and pain-reducing drug is injected through the disc cannula to reduce inflammatory substances in the treated disc.

You can find your medication here

Risks, side effects & dangers

As for one Discography Only twilight anesthesia is required and the examination is also carried out under X-ray control, serious complications or side effects are generally not to be expected.

The lateral puncture of the intervertebral disc to be examined is perceived as extremely uncomfortable by many people, despite the local anesthetic being applied. In addition, if blood vessels are injured, there is a risk of rebleeding. Irrespective of the continuous position control by the image converter, in very rare cases a nerve root can also be injured by the cannula.

In addition, even with minimally invasive interventions (bacterial) spreading of germs into the disc space, which can cause discitis (painful inflammation of the intervertebral disc), cannot be completely ruled out. In the case of a contrast agent allergy not known beforehand, a discography through the injection of contrast agents can lead to differently pronounced allergic reactions up to anaphylactic shock.

Since the distension test is based on subjectively perceived pain that cannot be checked by the examiner, a discography can lead to false positive or false negative results.