Discography, more precisely called provocation discography was previously
known as disc stimulation and discogram
Provocation discography (PD) is a diagnostic procedure to
evaluate the discs in between the vertebral bodies.
The goal of this procedure is to find out which disc (or discs) is (are) causing
the pain.
This can be done for any disc but is most commonly done in the lower back
(lumbar spine discs).
The indication for the procedure is suspected discogenic pain (pain that is
produced by the disc).
Sometimes discograms are ordered or performed by spine surgeons to find out
which one of potentially many diseased-looking discs is the main culprit so they
can proceed with the operation.
With new treatment modalities available for interventional pain specialists,
PD is used to diagnosed internal disc disruption/annular tears of the
disc. If a painful disc is shown on post-discogram CT to have annular fissures,
it may be a candidate for any of the intra-discal electrothermy procedures (see
IDET).
Procedure in detail: Discograms, being provocation tests are painful.
For a lumbar discogram the patient is positioned on the stomach. Long needles
are inserted off the midline to get into the discs. Usually at least 3 needles
are placed. One is above the suspected level, one at the suspected level and one
below. In a best-case scenario injection of contrast media under fluoroscopy
will cause the patient's typical pain at the diseased level but not at the other
(control) levels.
Usually a CT-scan with thin cuts through the discs is ordered after the
discogram.
Complications: The most feared serious complication associated with
discograms is infection (discitis). As the disc is poorly vascularized and has
poor blood flow and metabolisms, it is a serious complication. Patients will be
on long-term antibiotics.
Most pain specialists will give some antibiotics during the procedure to
minimize the risk but it is not possible to eliminate the risk of infection even
when using strict aseptic technique coupled with antibiotics during the
procedure.
We will soon upload pictures of discograms here. | 
