Back Pain Diagnosis with Discography
Tory McJunkin, MD, is a pain specialist at Banner Estrella Surgery Center, 9301 W. Thomas Road, Phoenix. His office can be reached at (480) 563-6400.
Question: I suffer from chronic pain in my lower back. Is there anything that can help me?
Answer: Low back pain affects approximately 80 percent of the general population at least sometime during their lifetime. It is also the fifth leading cause of physician visits, as well as the leading cause of work-related disability. Discography has been used to diagnosis the cause of low back and neck pain, especially when non-invasive imaging, such as magnetic resonance imaging (MRI), does not reveal abnormalities consistent with the pain symptoms.
Your back is uniquely designed to support, protect, and transport you. You have a bony support structure called your vertebrae or spine, which house the spinal cord and exiting nerves. Between vertebrae you have discs, which are made up of tough collagen. The discs act as shock absorbers, cushioning impact much like shock absorbers on your car.
The disc itself can tear or bulge and aggravate nearby nerves or other structures. When you have disc related pain you may complain of pain that radiates into your leg or causes a band of constant pain in your low back.
Discography is a diagnostic tool available to determine whether certain discs of the spine are the source of a patient’s neck or back pain. During this procedure, a small needle with local anesthetic is injected into the skin to numb the area. A different needle is then inserted through the anesthetized skin and is positioned within the outer layer of the disc. Fluoroscopy, real time X-ray, is used in order to assure proper placement of the needle.
A contrast solution is then injected into the disc and the patient’s response to the injection is observed at different locations. If pain is experienced that is similar to the chronic pain condition being experienced by the patient, then it is possible that your doctor has located the source of your pain. This process is typically repeated at two additional levels. The procedure generally takes about 30 minutes to an hour.
As with all medications and interventions, there is always a risk of complications. Typically discography is considered low risk with minimal complications. Although uncommon, discitis can be severe. Discitis is an infection of the disc and presents as pain. Other risks are bleeding, hematoma, headache and increased pain.
After the results from your discography are reviewed, the pain physician will devise a treatment plan that will increase the patient’s level of function, as well as decrease or eliminate your pain.