Provocative Discography

Provocative discography is a test to determine if the diseased intervertebral disc is the cause of a patient’s pain. Intervertebral disc pathology is a common cause of persistent pain in the lower back, neck, and rarely the thoracic spine. Inconclusive radiographic and magnetic imaging in patients with persistent, debilitating pain usually make this test necessary in order for other more advanced procedures or surgical consideration to be considered.

During the procedure, the patient lies face down on the procedure table in a clean operating room. The patient’s vitals signs are collected and checked for appropriateness. The patient’s back, in the appropriate area (cervical or lumbar), is cleaned with an antiseptic and draped using sterile technique. Using fluoroscopic (low dose x-ray) guidance, the appropriate intervertebral disc is identified and the skin is anesthetized. Using a needle, the intervertebral disc space is entered using fluoroscopic guidance from a posterolateral approach. The disc is pressurized to determine if this disc is the pain generator. The patient will feel pressure and discomfort as the solution with contrast is injected. More than one level is checked to verify location. Local anesthetic (numbing medications) may be injected at the painful location. The patient will be sent to have a post procedure CT scan to further evaluate the integrity of the intervertebral disc which is better visualized now that contrast has been injected. The patient’s back may have discomfort where the needle was inserted over the next few days, but this will resolve.