A disc is a cushion like structure located between the bones of the spine. It has a tough outer shell called the annulus, and a softer inside called the nucleus pulposus. A disc stretches and compresses to allow the spine to twist and bend. It is thought that pain can arise from a disc, especially from the annulus. The annulus is multi-layered, and sometimes the annulus can tear straight through, or the layers can separate from each other. Nerve endings in the annulus can sense this and send pain signals. Provocative discography involves inserting a needle into the nucleus of a disc and injecting dye. The dye can reveal tears not seen on MRI. More importantly, the injection of a small amount of dye can put pressure on the inside of the disc. Normally, you would only feel some pressure in your back when this is done, but, if the disc is “bad”, you may experience reproduction of your pain. If this happens, then this would mean that this disc is likely involved in your pain syndrome. This procedure is not intended to give you any relief. It is for diagnosis only, to “provoke” and identify the source of your pain. If your pain is originating from your discs, then something else can be done. Traditionally at this point, the patient’s choice was surgery. However, in some cases, minimally invasive procedures such as neucleoplasty and I.D.E.T might correct the problem.
An IV will first be placed in your arm. You will be placed prone (face down) on the fluoroscopy table. Your low back will be cleansed with an antiseptic and then numbed. The doctor will use X-ray to help guide the needle into the disc. Next, a very small amount of dye will be injected into the disc to confirm correct placement of the needle and also to look for any abnormalities that may be responsible for your pain syndrome. The procedure will take about 30 to 60 minutes. A Band-Aid will be applied to each injection site, and you will be taken to the recovery area where the nurse will monitor your blood pressure and pulse for about 20 minutes. A nurse will review your discharge instructions with you before going home.