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What are Intervertebral Discs? Intervertrebral disks are seen between the bony vertebrae of the spine. These soft disks support the vertebrae, keep them together, and assist with motion. They are located in the neck, upper back, and lower back. The disks in the lower back are called lumbar disks.
Each disk has two parts. It is similar to a jelly donut. The inner part of the disc, analgous to the jelly, is called the Nucleus Pulposus. The outside portion of the disc is referred to as the anulus. The Anulus is the only part of the disc with nerve endings that are sensitive to pain.
What leads to pain in an intervertebral disk? If an intervertebral disc tears, chemicals inside the nucleus may leak out. This can inflame the nerve endings in the outer part of the disc, the anulus, and cause lower back pain. Nerve roots and the protective covering of the spinal cord (called the dura) are also sensitive to these chemicals.
When the dura or nerve roots in the lower back are involved, it causes leg and low back pain. An untreated disc tear may cause a disc to bulge or herniate. A herniation is when the nucleus (jelly of the donut) squeezes out of its covering. This can further inflame or compress the nerve roots (Pinched Nerve) and cause even more pain. This signifies that early diagnosis of tears in the disc is important.
How do I know if I have disc pain? If you have pain in your lower back or legs and it has not improved with treatment, you may have lumbar disc pain.
Common studies such as an MRI may show nerve root compression and disc bulging, but may not show disc tears all the time. Discography is the best way to diagnose torn discs.
What is a Diskography? Discography is a test that assists the doctor to find disc tears that can be the source of pain. During discography, a thin needle is inserted into the center of a disc. A contrast dye which shows up on xray will be injected into the disk.
The pressure from the fluid helps identify whether or not the disc is painful. The dye will outline the tears in the disc. This is often done to several discs to find the specific disc or discs that are causing your pain. The picture shows multiple tears in the disc between L5 and S1. As you can see at L4-L5 disc, the contrast dye is well contained.
What happens during a Discogram? A local anaesthetic will be utilized to numb the skin. The physician the inserts a needle directly into a disk. Fluoroscopy, a real time xray, must be utilized to ensure the proper and safe needle positioning. A dye is then injected to outline the disc tear. A discogram is simply a diagnostic test to determine whether or not the source of one’s pain emanates from an intervertebral disc. It has no curative benefit.
It is imperative to describe pain felt to your physician. During a discogram, a healthy disc should not cause your usual back pain, but a torn disc may. If a different soreness or pain is felt, be certain to explain that it hurts but the pain is not your usual everyday pain. This will help the doctor determine which disc may be responsible for your pain.
The doctor will test several levels during a diskogram in an effort to establish a control level to compare to the affected disc level.
What occurs after a Discogram? You will be monitored for a period after the procedure, then discharged. You will be prescribed a CT scan to obtain an image of your disks. You may typically return to work one to two days after the procedure.
You will follow up with your ordering physician to analyze the results and decide on treatment options.