|
Introduction
One of the causes of back pain is degeneration of the discs between the bones of the spine. This internal deterioration may give rise to irritation of the little nerves supplying the disc. X-rays and scans may show a narrowed shrunken disc but do not tell us whether the disc is actively causing pain or not.
The Procedure
A discogram is one method of gathering information about your disc. It involves:
Fasting (no food or drink) for 4 hours prior to the procedure which lasts approximately 45 minutes
You may eat and drink once you are awake (usually an hour after the procedure)
You will be almost completely asleep during the procedure and are unlikely to remember much afterwards
There will be no dressing
The nurse will check to make sure that you are fit enough to have the procedure. The doctor or nurse will place a small cannula (a hollow tube) into the back of your hand. Through this cannula a medicine is injected which will make you sleepy. The procedure will be performed in an operating theatre. You will be asked to lie on your left side on the operating table. The procedure will be done under X-ray guidance. The X-rays used are a much smaller dose than you would receive if you have a normal X-ray.
The doctor will clean your back with a warm solution of disinfectant and cover your back with sterile drapes. You will be given a local anaesthetic and then a needle will be placed into the intervertebral disc in the spine and an antibiotic and radio opaque dye will be injected.
A normal or innocent worn out disc will not react to this, but one which is causing you trouble will cause you discomfort. For an inflamed disc that is giving you pain, the treatment is an injection of local anaesthetic and cortisone (a steroid) into the disc. This aims to calm down the irritation inside it. Although primarily not a treatment, discography offers a chance of treating a painful disc. When treated with steroids there is a 60% chance of relieving the pain for a few weeks, sometimes longer.
Please Note:
Please bring with you a list of your current medication.
• Please arrange for someone to drive you home and stay with you for the rest of the day until the effects of the sedative have worn off
• You may drive 24 hours after the procedure if you feel able to
• You may return to work after 36 hours if your job is sedentary and 2-3 days if manual
The Disgogram Results
Sometimes patients are referred from an orthopaedic surgeon purely for the test. The result of your discogram will be sent back to him and he will discuss the results and the treatment options with you. In some cases treatment to the offending disc (local anaesthetic and cortisone) may be offered at the same time as the discogram, if an operation is not planned. Sometimes this can mean that an operation can be avoided.
Risks
If there is a large disc bulge and the pressure on the disc is then increased during the discogram, there is a possibility of further prolapse (slipped disc). This would cause more pressure on the nerve,but is very rare
It is possible to experience an allergic reaction to the dye that is used in order for the disc to be displayed on X-ray. Infection of the disc (discitis) is also a possibility.
You may feel ‘groggy’ for up to an hour after the procedure. You will not be fit to drive home because the effects of the drug will impair your reflexes for the rest of the day
There will be some discomfort in the back after the local anaesthetic has worn off and this pain may last for a day or two.
Benefits
A diagnosis is often made or confirmed and if there has been treatment, the pain relief should gradually allow you to increase your activities. Any benefit may take up to two weeks to start. If you have received treatment, we suggest that you start exercising in a mild fashion, taking two walks a day but limiting the distance and time to the level that you know you can manage easily.
You should be able to reduce your drug intake, sleep should be improved and you should concentrate on improving Posture and low back stability with a Pilates type exercise programme.
Useful Addresses
If you have any questions please ask a member of the nursing staff who will be happy to help you. You may find other useful information at:
www.backcare.org.uk or www.britishpainsociety.org
Frequently Asked Questions
WHAT IS CORTISONE?
Cortisone is a powerful anti-inflammatory medicine which reduces inflammation around the nerve tissue and can break into the cycle of entrapment and swelling. This reduces pain, numbness, weakness.
IS THERE A LIMIT TO THE NUMBER OF INJECTIONS YOU CAN HAVE?
In any particular place in the body there is a natural limit of three injections in a 6 week period. Further injections are allowed in other places and at other times especially if they are effective. Your specialist will guide you.
WHAT COMPLICATIONS MAY OCCUR?
Hot flushes for 2 days.
Allergic reaction to any injection may occur in 1 in 7000 cases. This may just be a rash or a life threatening reaction. These will usually occur immediately and will be treated immediately. Most reactions are treated and cause no permanent harm.
Bleeding - Epidural Haematoma and resulting nerve damage is a very rare (1 in 7000) complication after a bleed around the nerves. This usually requires surgery to remedy.
Infection – Very rarely (1 in 7000). An Epidural Abscess or infection in other tissues can occur rarely. You should watch for signs of fever, redness, swelling and increasing pain. This can be treated with antibiotics or even surgery.
Spinal Fluid Leak – This causes a very bad headache, nausea/vomiting which goes away on lying down. This rarely lasts more than a few days.
|
