What is Discogram?

A discogram, also known as discography, is a diagnostic imaging test used to pinpoint the source of chronic back pain. It's particularly helpful when other imaging tests like MRI or CT scans haven't clearly identified the cause of your pain. Think of it as a way to "pressure test" your spinal discs to see if they are the source of your discomfort.

The procedure involves injecting a contrast dye into one or more spinal discs and observing your pain response and the images produced via X-ray or CT scan. The idea is to reproduce your typical back pain to confirm which disc is the problem. It's important to understand that discograms are not always the first line of investigation and are usually considered when conservative treatments haven't provided relief.

Key Facts:

• Purpose: Identifies painful spinal discs.
• Method: Injection of contrast dye into discs.
• Imaging: Uses X-ray or CT scan.
• Not a First-Line Test: Used when other tests are inconclusive.
• Controversial: Not universally accepted due to potential for false positives and limited evidence of improved surgical outcomes.

Why is Discogram Performed?

A discogram is performed to determine if a specific spinal disc is the source of chronic back pain, especially when the cause is unclear. Here's when it might be considered:

Main Conditions/Indications:

• Chronic Back Pain: Pain that persists despite medication, physical therapy, and other conservative treatments.
• Suspected Disc Herniation: To confirm if a herniated disc is the source of pain when MRI results are unclear.
• Degenerative Disc Disease: To assess the extent to which damaged discs are causing pain.
• Pre-Surgical Planning: To determine which discs need to be addressed during spinal fusion surgery.
• Failed Back Surgery Syndrome: To identify if a previously untreated disc is now causing pain after surgery.

When Doctors Recommend It:

Doctors typically recommend a discogram when:

• You have persistent back pain that hasn't responded to conservative treatments for at least six months.
• Other imaging tests (MRI, CT scans) haven't provided a clear diagnosis.
• Surgery is being considered, and the surgeon needs to pinpoint the exact source of the pain.
• The doctor suspects a specific disc is the source of pain, but needs confirmation.

Preparation for Discogram

Proper preparation is crucial for a successful discogram and to minimize potential complications. Here's what you need to do:

Essential Preparation Steps:

• Medical History Review: Inform your doctor about all your medical conditions, allergies, and medications you are taking, including over-the-counter drugs and supplements.
• Medication Adjustments: You may need to stop taking blood-thinning medications (like aspirin, warfarin, or clopidogrel) several days before the procedure. Your doctor will provide specific instructions.
• Fasting: You may be advised to fast for several hours (typically 6-8 hours) before the procedure. Your doctor will specify the fasting requirements.
• Transportation: Arrange for someone to drive you home after the procedure, as you may experience some discomfort and shouldn't drive yourself.
• Do Not Take Pain Medications: Avoid taking pain medications on the day of the procedure, as they can interfere with the accuracy of the pain assessment during the discogram.
• Comfortable Clothing: Wear loose, comfortable clothing on the day of the procedure.
• Mental Preparation: Understand the procedure and what to expect. Discuss any concerns or anxieties with your doctor.

India-Specific Tips:

• Consult Your Physician: Discuss whether your current medications need adjusting prior to the procedure.
• Documents: Carry your Aadhar card and any previous medical records related to your back pain and other imaging results (MRI, CT scans).
• Hospital Choice: Research reputable hospitals or clinics in your area that perform discograms and have experienced spine interventionalists. Consider hospitals in major cities like Mumbai, Delhi, Bangalore, Chennai, and Kolkata.
• PCPNDT Act: While not directly related to discography, be aware of the Pre-Conception and Pre-Natal Diagnostic Techniques (PCPNDT) Act, which regulates prenatal diagnostic techniques.
• Language Support: If you're not comfortable speaking English or Hindi, ensure the hospital provides translation services.

What to Expect:

• You will be asked about your pain levels and characteristics before, during, and after the procedure.
• Your blood pressure, heart rate, and oxygen levels will be monitored throughout the procedure.
• You will lie face down on an X-ray table.
• The skin on your back will be cleansed with an antiseptic solution.
• A local anesthetic will be injected to numb the area where the needle will be inserted.

The Discogram Procedure

The discogram procedure typically takes between 30 to 60 minutes and involves the following steps:

Step-by-Step:

1. Positioning: You will lie face down on an X-ray table.
2. Skin Preparation: The skin on your back will be cleaned with an antiseptic solution.
3. Local Anesthesia: A local anesthetic will be injected to numb the area where the needle will be inserted.
4. Needle Insertion: Using X-ray guidance (fluoroscopy or CT scan), a thin needle is carefully inserted into the center of the targeted spinal disc. This is often the most uncomfortable part of the procedure, but the local anesthetic helps minimize the pain.
5. Contrast Injection: Once the needle is in place, a contrast dye is injected into the disc.
6. Pressure Monitoring: The doctor will monitor the pressure inside the disc and ask you to describe any pain you experience during the injection. The goal is to see if the injection recreates your usual back pain.
7. Image Capture: X-rays or CT scans are taken to visualize the spread of the contrast dye within the disc.
8. Repeat (if needed): The procedure may be repeated on other discs to assess multiple potential pain sources.
9. Needle Removal: After all the targeted discs have been assessed, the needles are removed.
10. Bandaging: A small bandage is applied to the injection site.

Duration, Comfort Level:

• Duration: The entire procedure usually takes between 30 and 60 minutes.
• Comfort Level: You may experience some discomfort or pressure during the needle insertion and dye injection. Most patients report that the pain is tolerable. It's crucial to communicate any pain or discomfort to your doctor during the procedure.

What Happens During the Test:

During the discogram, you will be asked to rate the pain you experience on a scale of 0 to 10 and describe its characteristics (e.g., sharp, dull, aching). The doctor will be looking for two key things:

• Pain Reproduction: Does the injection recreate the pain you normally experience in your back?
• Disc Morphology: How does the contrast dye spread within the disc? Abnormal patterns of dye spread can indicate disc damage or degeneration.

Understanding Results

Interpreting discogram results requires careful consideration of both the imaging findings and your pain response.

Normal vs. Abnormal Ranges (if applicable):

There aren't specific "normal" or "abnormal" numerical ranges in a discogram. Instead, the interpretation relies on a combination of factors:

• Pain Response:
  • Positive Discogram: The injection reproduces your typical back pain, indicating that the disc is likely the source of your pain. The pain should be similar in location and intensity to your usual pain.
  • Negative Discogram: The injection does not reproduce your typical back pain, suggesting that the disc is not the primary source of your pain.
  • Discordant Discogram: The injection causes pain, but it's different from your usual back pain. This result can be difficult to interpret.
• Imaging Findings:
  • Normal Disc: The contrast dye spreads evenly within the disc space, indicating a healthy disc.
  • Abnormal Disc: The contrast dye leaks out of the disc space, indicating damage or degeneration. The shape and extent of the dye leakage can provide information about the severity of the disc problem.

What Results Mean:

• Positive Discogram with Concordant Pain: This suggests that the injected disc is likely the source of your back pain. However, it's important to remember that even with a positive discogram, the disc might not be the only source of your pain.
• Negative Discogram: This suggests that the injected disc is not the primary source of your pain. Other potential causes of your back pain should be investigated.
• Discordant Discogram: The meaning of a discordant discogram is less clear. It could indicate that the disc is contributing to your pain, but it's not the sole source. It could also be a false positive result.

Next Steps:

Your doctor will combine the discogram results with other information, such as your medical history, physical exam findings, and other imaging results (MRI, CT scans), to develop a comprehensive treatment plan. Possible next steps may include:

• Conservative Treatment: If the discogram is negative or discordant, or if surgery is not an option, conservative treatments such as physical therapy, pain medications, and injections may be continued or adjusted.
• Surgery: If the discogram is positive and surgery is being considered, the results can help guide the surgical approach. The surgeon will use the discogram to determine which discs need to be addressed during the procedure. Common surgical options include spinal fusion or disc replacement.
• Further Diagnostic Testing: In some cases, further diagnostic testing may be needed to identify other potential sources of your back pain.

Costs in India

The cost of a discogram in India can vary depending on several factors, including the city, the type of hospital (government vs. private), and the complexity of the procedure (number of discs injected).

Price Range in ₹:

• Tier-1 Cities (Mumbai, Delhi, Bangalore, Chennai, Kolkata): ₹25,000 - ₹50,000 per disc level.
• Tier-2 Cities (Pune, Hyderabad, Ahmedabad): ₹20,000 - ₹40,000 per disc level.

Government vs. Private:

• Government Hospitals: Discograms may be available at a lower cost (or even free) in government hospitals, but there may be longer waiting times and limited availability.
• Private Hospitals: Private hospitals generally offer more advanced technology and shorter waiting times, but the cost will be higher.

Insurance Tips:

• Check Your Insurance Policy: Contact your insurance provider to determine if a discogram is covered under your policy. Inquire about any pre-authorization requirements or limitations on coverage.
• Network Hospitals: Choose a hospital that is part of your insurance company's network to maximize your coverage and minimize out-of-pocket expenses.
• Cashless Facility: If possible, opt for a cashless facility at the hospital to avoid paying upfront and getting reimbursed later.
• Document Everything: Keep copies of all your medical bills, insurance claims, and correspondence with the insurance company.

Note: These are approximate costs and are subject to change. It is recommended to contact hospitals and clinics directly to get accurate and up-to-date pricing information.

How Ayu Helps

Ayu can help you manage your health information related to your discogram and back pain.

• Digitally Store Results: Securely store your discogram reports, MRI images, and other medical records on the Ayu platform.
• Track Over Time & Share via QR: Track your pain levels, medications, and treatment progress over time. Easily share your medical records with your doctor or other healthcare providers by generating a QR code. This helps ensure your doctor has all the relevant information for your care.

FAQ

Here are some frequently asked questions about discograms:

Q1: Is a discogram painful?

A: You may experience some discomfort during the needle insertion and dye injection, but the local anesthetic helps minimize the pain. Communicate any pain to your doctor.

Q2: How long does it take to recover from a discogram?

A: Most people can return to their normal activities within a day or two. You may experience some soreness at the injection site.

Q3: What are the risks of a discogram?

A: Risks are rare but can include infection, bleeding, nerve damage, allergic reaction to the dye, and worsening of pain.

Q4: Is a discogram always accurate?

A: Discograms are not always accurate. False positive and false negative results can occur. The results should be interpreted in conjunction with other clinical findings.

Q5: Can a discogram cure my back pain?

A: No, a discogram is a diagnostic test, not a treatment. It helps identify the source of your pain so that appropriate treatment can be planned.

Q6: What should I do if I experience severe pain or other symptoms after a discogram?

A: Contact your doctor immediately if you experience severe pain, fever, redness or swelling at the injection site, weakness, or numbness.

Q7: Are there alternative tests to a discogram?

A: MRI and CT scans are often used before a discogram. Nerve conduction studies or other diagnostic tests may be considered depending on your specific symptoms.

Q8: How do I choose a doctor for a discogram?

A: Choose a doctor who is a qualified spine interventionalist or pain management specialist with experience performing discograms. Look for a doctor who is board-certified and has a good reputation.