Treating lower back pain is one of the most difficult assignments in modern medicine. Back pain has multiple causes, and patients perceive pain differently. This combination can make it difficult for a pain specialist to adequately address a patient’s back pain despite years of trying different treatments. Discography is sometimes offered as a solution.
Discography is a diagnostic procedure that looks to identify the underlying causes of lower back pain prior to an invasive surgical procedure, like spinal fusion. Its efficacy as a diagnostic tool is a matter of debate. By no means is discography settled science.
Proponents insist that discography provides important information doctors cannot obtain any other way. Critics say that the results of the procedure are not always trustworthy. Furthermore, a discography performed by someone other than a specialist may not yield beneficial results at all.
Uncomfortable but Minimally Invasive
The first thing to know about discography is that it is an uncomfortable procedure. On the other hand, it is minimally invasive. It is an injection procedure involving needles and fluids. Doctors do not have to use scalpels to cut into tissue in order to perform the procedure.
Discography begins with the patient lying on an exam table, face down. The doctor identifies the target area based on patient reports of pain, then numbs the skin with a topical anesthetic. Next, a needle is inserted into the suspect disc with the help of fluoroscopy.
A fluid is injected into the disc to create pressure. Depending on the patient’s response to that pressure, the doctor can determine whether or not the targeted disc is the source of pain. That determination is followed by injecting a dye and noting whether or not any leakage occurs.
Doctors often have to inject multiple discs to determine the source of a patient’s pain. Meanwhile, the patient is not informed as to which disc is being injected at any particular time. The reason behind this is to keep the patient’s responses as subjective as possible.
When Discography Is Appropriate
Despite some in the medical profession being opposed to discography, the procedure is quite common. Some health insurance companies readily cover the procedure if a doctor believes it is medically necessary. How is that determined?
Lone Star Pain Medicine is a Weatherford, Texas pain clinic that utilizes discography alongside a number of other diagnostic tools. They say that discography is usually only recommended after a patient has exhausted all other means of noninvasive treatment.
In such cases, discography is utilized to help determine whether or not more invasive treatments are warranted. For example, a doctor might recommend discography before approving back surgery.
As with any medical procedure, discography does have its risks. The most prominent among them are infection at the injection site and an infection of the disc, known as discitis. Nerve damage is another risk. In rare cases, an improperly performed procedure can actually injure the back more seriously.
Discography’s risks are exacerbated by the fact that the results of the test are entirely subjective. The procedure isn’t like an x-ray, where taking an image of a bone clearly shows a fracture. Discography relies more on patient perceptions of pain than anything else.
Some things in the world of medicine offer proven efficacy for most patients. Others do not. Discography is part of the latter category. Though back specialists and pain doctors alike may turn to discography before recommending invasive back surgery, it is not necessarily a given that the procedure will yield useable results. In essence, discography is not settled science.