A test that identifies whether a specific disc is the source of pain. It is the only test that asks the disc directly.
What it is
Contrast (dye that shows on X-ray) is injected into a disc under pressure while you tell us what you feel. A positive result brings back your usual pain at one level, but not at the nearby control levels. We use it only in select cases, mainly before surgery decisions.
What we use it for
- Deciding whether a specific disc is generating pain
- Planning before fusion or disc replacement
- When imaging shows several abnormal discs and only one is causing symptoms
What to expect
- You stay awake and responsive — your feedback is the test.
- Under fluoroscopy, 30 to 45 minutes.
- Increased pain for a few days afterwards is common.
- No sedation is used, so most patients drive themselves home. If a leg feels weak or numb, have someone else drive until that wears off.
Risks
The best-known risk is discitis, an infection inside the disc. It is uncommon but serious. That is why we use strict sterile technique and often give antibiotics ahead of time to prevent it. More back pain for several days afterwards is expected. There is longer-term evidence associating disc puncture with faster degeneration (breaking down of the disc). That is exactly why this test is used only in select cases, not as a routine.
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How we judge whether it worked
You stay awake and responsive because your report is the result. A positive test brings back your usual pain at one level, but not at the nearby control levels.
It is used to answer a surgery question, not to go looking. If the result would not change a decision, the test is not needed.
Before and after your procedure
No sedation is used, so most patients drive themselves home. If a leg feels weak or numb, have someone else drive until that wears off. You will be awake and asked to report what you feel — that reporting is the test, so no sedation is used. Expect increased back pain for several days afterwards. Antibiotics are usually given because disc infection, while uncommon, is serious. Report fever, escalating pain or night sweats in the following weeks.
How the procedure is actually done
Discography is a provocation test (it tries to set off your pain), not an imaging study. Using live X-ray, called fluoroscopy, we place a needle into the center of a disc. Then contrast is injected while we watch the pressure. The question is whether that one disc brings back your own usual pain. Control discs are tested in the same visit. A positive result needs the suspect disc to bring back the pain and the nearby normal discs not to.
Who it suits, and who it does not
It suits a narrow group. These are patients with lasting axial back pain (pain in the spine itself) where a disc is suspected. Other sources have been ruled out. And a decision such as fusion depends on knowing which level is to blame. It is not a screening test and not a treatment. It is not right when a surgery decision is not truly on the table.
What we do before offering this
The assessment comes first. We look at what the pain does across a day and what sets it off or eases it. We look at what the exam brings on, and what past treatments did and for how long. Partial and short-lived results are very telling, so we ask about them directly. We offer a procedure only when that picture points to one clear structure. We explain the reasoning. We do not assume you know it.
Common questions
Why do I have to be awake?
Because the result is whether the injection reproduces your usual pain. Sedation would blur that report, and with it the test.
Will it hurt?
It is meant to bring back your pain, so the answer is often yes, for a short time. That pain is the result of the test.
Why are normal discs tested too?
As controls. A disc that hurts when every disc hurts tells you nothing. The test only means something when one disc stands out.
Is it still used?
Yes, in select cases, when the answer will change a decision. It is not a routine step in checking back pain.
Sources
- Manchikanti L et al. An update of the systematic appraisal of the accuracy and utility of lumbar discography in chronic low back pain. Pain physician, 2013. PubMed 23615887
- Fang C et al. The correlation between the high-intensity zone on a T2-weighted MRI and positive outcomes of discography: a meta-analysis. Journal of orthopaedic surgery and research, 2017. PubMed 28178999
- Fardon DF et al. Lumbar disc nomenclature: version 2.0: Recommendations of the combined task forces of the North American Spine Society, the American Society of Spine Radiology and the American Society of Neuroradiology. The spine journal : official journal of the North American Spine Society, 2014. PubMed 24768732
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