Diagnostic Lumbar Discogram

Your referring physician has requested that you have a diagnostic lumbar discogram. The following is a description of the procedure and potential complications, so that you may provide informed consent prior to the procedure. 

A lumbar discogram is an invasive procedure with some uncommon risks. After local anesthesia, fluoroscopic (x-ray) guidance will be used to place needles into the lumbar spine discs. The discs will be individually studied by injecting contrast (x-ray dye), and putting the discs under pressure. The appearance of the discs on the x-ray (fluoroscopic) image and your response to the injection will be monitored. A discogram is the ONLY known way to study an individual disc. We will be trying to help your spine surgeon decide whether one or more of your discs are potential sources of your pain for which your physician may be considering surgery. We are evaluating for any pain during the discogram and comparing it with your typical pain.  We will discuss your typical pain extensively with you prior to the procedure. Because we are evaluating your pain, we cannot give pain medication or sedative prior to the procedure. Typically we will give you pain medication in the hospital following the procedure.  You may take your standard prescribed home pain medication after discharge. Typically, 3 lumbar discs are studied but more may be studied in certain cases. A CT (or CAT scan) is almost always done after the procedure.  If no intramuscular (IM) or intravenous (IV) pain medications are given, you can be discharged home immediately after the CT.  If IM or IV medications are given, you will need to be monitored for a while afterwards. 

Most complications of lumbar discograms are uncommon and the procedure is very safe. You need to know the potential complications which include: 

1. BLEEDING. As with all needle procedures, bleeding can occur. As long as you have no bleeding tendency and are not on any blood thinners such as Coumadin or Plavix, bleeding complications are extremely rare. However, patients have had to undergo emergency surgery to relieve pressure on the nerve roots and spinal cord because of bleeding after needle procedures like discograms. 
2. INFECTION. Any needle passing through the skin can introduce infection, so there is a rare risk of infection such as discitis. Discitis is an extremely painful condition and may occur in up to 1% of disc spaces studied. Therefore, in general, you will receive IV antibiotics prior to the procedure and sterile technique will be used. The needle entering the disc actually does not pass through the skin, instead going through a guiding needle first. If discitis does occur, it may take a lengthy time after the procedure to present. Discitis is treatable by IV antibiotics but typically leads to fusion of the disc and may even require surgery. 
3. NERVE INJURY. As the needles are placed into the disc, they pass immediately adjacent to nerves that exit the spine. These nerves may be irritated by the needle, causing severe sharp shooting pain/electric shock sensation down the leg on the side the needle is placed. If nerve irritation occurs, it resolves quickly as the needle is repositioned. Permanent injury to the nerve root is extremely rare. 
4. SPINAL HEADACHE. Rarely, in order to access a lumbar disc (usually L5/S1 disc), the guiding needle needs to be placed first through the fibrous sac containing spinal fluid and nerve roots rather than to the side of the spine. Basically this approach is a lumbar puncture and then has a separate risk of spinal headache. Small holes are made in both the back and front of the fibrous sac while passing through to reach the disc. If these holes do not close after the needle puncture, the spinal fluid inside can then leak out, and if significant, the brain loses the cushioning effect of the fluid which causes a severe headache when you sit or stand. Spinal headache has been reported in up to 30-40% of patients that have a lumbar puncture of any kind.  These headaches are usually very positional, meaning they start when you sit or stand and go away when you lie down. It is important that you follow any instructions for bedrest only getting up to go to the bathroom for 24 hours after your procedure, and to drink plenty of fluids. The bed rest is important to allow the small hole in the sac to heal and close. If you develop a spinal headache, it is OK to treat yourself. As long as you do not feel ill, do not have a fever, and the headache goes away when you lie down, you may treat yourself with another day of bed rest with bathroom privileges and drinking plenty of fluids. Caffeine often helps with these headaches as well, if your doctor normally allows you to have caffeine. These simple actions almost always work. If not, please contact the radiologist who performed the procedure.  Uncommonly a procedure called an epidural blood patch may be performed in the hospital with a very high success rate in treating spinal headaches that don’t resolve with bedrest.
5. ALLERGIC REACTION: The use of any medication, including x-ray contrast, has the possibility of producing an allergic reaction.  Please inform your physician of all of your known medical allergies before the procedure. 

Please feel free to ask any questions you may have about the procedure prior to signing the consent form.