If surgery is to be undertaken, it is clearly essential to identify as accurately as possible the source of the pain. Often this is obvious on the scans and X-rays but sometimes more than one potential cause is found or the cause is not entirely clear. In such situations further more invasive investigations can be helpful.
Discography involves the insertion of a needle into the disc using X-ray control. The disc is injected with contrast so that the disc can be "provoked". If provocation reproduces the pain at any particular disc it suggests that this is a source at least in part of your symptoms.
Local anaesthetic can be injected to see if the pain resolves which offers further evidence of the disc being the pain source.
Sedation is given during needle placement and then you are woken up, as it is essential that you are fully cooperative during the injection. The injection may cause some discomfort or pain but this is usually short lived.
After the operation you will be encouraged to mobilize as soon as possible with the assistance of physiotherapists and nurses. Once mobile enough to manage at home you can be discharged.
It is important to keep a record as to whether your pain is worse, the same, or better in the hours and days after your discography.
An outpatient appointment will be arranged.
Discography is a test rather than a treatment for your symptoms. You should get back to normal function very quickly after the procedure. The procedure is usually done as a day case.
In order to monitor the results of surgery you will be asked to complete outcome questionnaires from time to time.
Most patients do not suffer any adverse problems. Occasionally complications do occur and can require further treatment.
Nerve damage is rare during discography. If it occurs it can cause areas of numbness, pins and needles and weakness. Neuralgic pain can also be troublesome.
Cauda equina syndrome is very rare and occurs when the nerves to the bowel and bladder are affected. Any numbness around the bottom or problems with passing stool or water should be reported immediately.
Scar tissue can form around the nerve root tethering the nerve causing ongoing pain. Occasionally further surgery is required to free up the nerve.
Infections can occur in the wound and rarely deep in the disc. These can usually be treated with antibiotics but occasionally require surgical cleaning and debridement.
Damage to the lining of the nerve root (Dura) can result in a leak of fluid (csf). Rarely the leak persists and has to be repaired surgically.
Spasm can occur causing a short period of troublesome pain aggravating previous symptoms. This is treated if necessary by antispasmodic medication.
Anaesthetic complications will be explained by your anaesthetist.
Please be assured that every effort is made to avoid the complications listed and any others which can very rarely occur.
If you have any questions or wish to discuss things further please ask at any time. It is important that you have all the information you require about your procedure, and we will assist you in every way possible.
MR ANDREW HOWARD
Consultant Spinal and Orthopaedic Surgeon
Ref No D0205