Having Provocative Discography

For the investigation of Provocative Discography you will be asked to come in to the Nuffield Hospital Hampshire as a day case.

You can eat and drink normally beforehand but should restrict yourself to a light meal only. Please bring any scans and x-rays that you have with you when you come in.

After you have been admitted you will be seen by Dr Madeline Sampson, Consultant Radiologist, who will explain the procedure to you and what will happen. The procedure is performed in the theatre suite where we can ensure sterile conditions and where we have available all the necessary equipment such as screening x-ray machines (Image Intensifiers).

Before the start of the discography procedure you will be given analgesia and antibiotic cover intravenously through a cannula in your arm. You will be able to have some light sedation but it is important that you are sufficiently awake to be able to know what you are feeling as the procedure progresses. We are interested most particularly in whether rises in pressure within a damaged intervertebral disc provokes what you recognize as your typical back pain and how what you feel at that level differs from what you experience when a different disc, perhaps a normal disc, is injected.

You will be asked to lie on your left side and after some preliminary x-ray screening, local anaesthetic will be given before a very fine needle is introduced through the right side of the back and into one of the discs under x-ray control. The x-ray machine can be rotated around you as you lie on the examination table, allowing the position of the needle to be checked in both the side-on and frontal planes, so you don't need to move around. In fact it is important that you lie still throughout the procedure.

At least two discs will be looked at and if necessary three or even four can be examined. The discs are injected with a contrast medium (sometimes called a dye) which shows up on the x-ray screens and allows us to assess the internal structure and condition of the disc, for example revealing any internal disruption or tears. We will carefully record how much fluid goes into the disc (it is withdrawn afterwards) and the changes in pressure that occur as the disc is injected. All of this information is valuable and can be compared with normal values. Most importantly, however, we will ask you to describe what you are feeling as the discs are injected and the fluid withdrawn again. What sort of discomfort do you feel, if any? Where do you feel it? Is it like your typical pain or is it a different sort of discomfort? All of this will be carefully documented.

The procedure usually takes between an hour and an hour and a half and afterwards the needles are withdrawn. You will be asked to remain on bed rest and under observation for four to six hours. You may have some back ache after the discography but you will be given analgesia as required, and some to take home with you when you leave.

There may be a little bleeding around the needle site and this is one reason why we ask you to remain on bed rest for a while afterwards. A little bruising may come to the surface within the next few days. It is important that you let us know beforehand if you have any bleeding tendency or if you are taking an anticoagulant such as Warfarin.

We take preventative measures to avoid infection being introduced into the disc with the needle, using the antibiotic cover given prior to the procedure. You will also be given some oral antibiotics to take home with you.

Once you go home we would suggest that you take things gently for a few days and you may want to take a few days off work to recover. If you feel unwell or have any other concerns please don't hesitate to contact the ward.

A detailed report will be drawn up by Dr Sampson after the procedure and this, together with selected images of each disc, will be passed on to Mr Boeree. Arrangements will be made for a review appointment for you with Mr Boeree. Then the findings from the provocative discography, and your further management, can be discussed.

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