Lumbar Discography: Definition and Procedure

lumbar discography

La lumbar discography is an imaging test that allows you to study the structure of one or more intervertebral discs suspected of causing chronic low back pain.

Since the advent of techniques ofmedical imaging more efficient such as MRI and scanner (in particular the discoscanner), the practice of lumbar discographies has become very rare…

However, it is sometimes used before surgery on the Lumbar spine in order to to identify the intervertebral disc pathological.

Find out in this article all there is to know about the lumbar discography !

Intervertebral disc: anatomical reminder

Before defining the lumbar discography, it is essential to remind you of a few notions of anatomy. Nothing very complicated! You just have to know that our spine, which is also called "spine", is formed by vertebrae stacked on top of each other.

Each of these is separated from its neighbors (vertebrae above and below) by a kind of cushion called "intervertebral disc".

Le intervertebral disc is a structure fibrocartilaginous which acts as a shock absorber by absorbing the various mechanical stresses exerted on the spine.

What is lumbar discography?

La lumbar discography is a radiology examination which makes it possible to study the structure of one or more intervertebral discs of the lumbar spine suspected of causing chronic low back pain.

It is in fact a conventional radiography, but who is preceded by an injection, directly at the level of the intervertebral disc concerned, of a radiopaque product. The latter, as its name suggests, makes the intervertebral disc visible, which is not normally visible on X-rays being a soft tissue (better visible on MRI).

In addition, lumbar discography can also help to wake up lower back pain described by the patient, which helps to identify the pathological intervertebral disc.

Indeed, in many cases, we cannot clinically specify the structure or structures responsible for lumbar pain. Of the exams imaging are sometimes necessary for this, in particular the discography — although the latter has now been rendered obsolete since the advent of MRI and scanner.

How is a lumbar discography performed?

To identify the origin of chronic low back pain, your attending physician may prescribe a lumbar discography if he suspects a disc pathology such as lumbar herniation.

You will then be directed to a radiologist who will take care of performing the requested lumbar discography.

Here are the 3 main stages of a lumbar discography:

Before the exam

There is not much to prepare before a lumbar discography. The radiologist or one of his assistants will just make sure that you do not have any contraindication to x-rays (pregnancy for example) orallergy to radiopaque product which will be injected during the examination.

Performing the exam

On the day of the exam, you don't have to fast, all you have to do is go to the radiology office with your various medical documents (letter from the attending physician, your medical file, your old X-rays, etc.).

When it is your turn, you will be taken to the examination room, you will be asked to dress lightly (or you will be provided with a gown) and to remove your jewelry before being seated on the X-ray table, then:

  • You will be placed in lateral position and benefit from a light sedation in order to relax while remaining aware ;
  • The radiologist will identify clinically (visually and by palpation) the lumbar intervertebral disc to puncture;
  • The skin in your lumbar region will be fully and carefully disinfected using compresses soaked in an antiseptic product (betadine);
  • The radiologist will perform a local anesthesia at the needle insertion site.
  • The radiologist will insert a fine needle into the identified intervertebral disc and inject the radiopaque product.
  • Upon penetration of radiopaque product in the disk, it will appear in the control screen.
  • The images obtained will then be recorded to be given to the attending physician.
  • Lumbar discography can be supplemented by a scanner, discoscanner.

When injecting the radiopaque product, lower back pain can be triggered. You must report this pain to the radiologist so that he mentions it in his report.

Indeed, the injection of the product causes a increased pressure inside the intervertebral disc (raised intra-discal pressure). If the latter is healthy, there will be no pain. On the other hand, if it is sick, its gelatinous internal part is exteriorized (in the form of a hernia) and triggers pain pressing on a nerve root.

The presence of this pain has great diagnostic value because it allows precisely identify the intervertebral disc responsible for the symptoms of the patient and, if applicable, treat it in a targeted way.

All these steps only last one twenty minutes, but we must count on average 2 to 3 hours of presence to the office to collect the discography review to give to your attending physician.

After the exam

After performing a lumbar discography, it is recommended to:

  • Rest for about 24 hours to calm any pain.
  • Avoid driving or performing physical tasks for 48 hours after the exam.
  • Keep the lumbar dressing on for 24 hours to prevent the risk of infection.
  • Drink plenty of water, at least 2 liters on the day of the examination, to allow the body to recover better.

What are the contraindications of lumbar discography?

There are few contraindications to lumbar discography:

  • The pregnancy ;
  • An allergy to the radiopaque product;
  • A skin infection in the lumbar region;
  • An extended burn at the lumbar level…

What are the risks and adverse effects associated with lumbar discography?

La lumbar discography is an exam relatively invasive, since a gesture of puncture of an internal structure (disc) is necessary. There is therefore a risk of skin or disc infection, fortunately very low risk thanks to rigorous aseptic measures.

There is also an (exceptional) risk of nerve damage when inserting the puncture needle.

In addition, discography can lead to:

  • A sensation of heat during the injection of the radiopaque product;
  • An allergic reaction to the radiopaque product;
  • Exposure to ionizing radiation (X-ray).

References

[1] P. Rabischong, R. Louis, J. Vignaud, and C. Massare, “The intervertebral disc”, Anatomy clinica, flight. 1, no 1, p. 55-64, 1978.

[2] SR DOSSOU, “ASSESSMENT OF THE LUMBALGIC PATIENT”, 2011.

[3] J.-L. Drapé, F. Bach, H. Guerini, S. Malan, L. Sarazin, and A. Chevrot, “Imaging examinations in degenerative lumbar pathology”, EMC-Rheumatology-Orthopedics, flight. 1, no 5, p. 365-394, 2004.

[4] J. Cauchoix, C. Masare, M. Benoist, A. Deburge, and S. Hautier, “La discographie lumbar. Its interest in the diagnosis and surgical treatment of painful, lumbar and lumbosacral discopathies. », Med Press, flight. 75, no 54, p. 2751‑6, Dec. 1967.

[5] “Discography examination of the intervertebral disc – Compiègne”, acrim. https://www.acrim.fr/nos-examens/radiologie/discographie/ (accessed October 29, 2022).

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