For Study Purpose(SK.SHAHWAZ)

1. Treating Chronic Back Pain: New Knowledge, More Choices
Branch: Bachelor Of Radiological Imaging
Technology
2nd Year
Skra727830@gmail.com

2. INTRODUCTION
 It is a radiological procedure to demonstrate the
intervertebral disc by injected the radiographic
contrast media.
 A discography, or discogram ,is aminimally
invasive diagnostic imaging test that help to
determine whether a specific intervertebral disc
may be the source of back pain . when disc bulge or
rapture , they press on the nerve of the cervical or
spinal column and cause of pain and weakness.
 A contrast material is injected into the center of one
or more spinal disc using x-ray guidence .This
injection may temporarily reproduce the patient’s
back pain symptoms.

3. NORMAL ANATOMY

4. NORMAL ANATOMY

6. INDICATION
 LBP(Low Back Pain)
 Disc bulging/rupture
 Painful pseudarthrosis
 Posterolateral lumber fusion
 Discogenic pain
 Confirmation of normal disc above or below a
proposed surgical fusion
 Tumour around the intervertebral disc
 Truma
 Tuberculosis in intervertebral disc
 Osteoarthritis(Bamboo spine)
 Old ages

7.  Normal Architecture of the Disc
 Pathophysiology of Disc related pain
 Intradiscal Procedures for
 Discogenic pain
 Herniated disc
 Disc Degeneration
 Nucleotomy

9. Nucleous Pulposus
ANNULUS FIBROSUS
END PLATE

10. DISCOGENIC BACK PAIN

11. RISK FACTORS
Life style:
Lack of Exercise
Obesity
Smoking
Prolonged
sitting

12. CONTRAINDICATION
 Iodine contrast sensitivity(if patient have previous
history of reaction to contrast media)
 Pregnancy
 Any local or distant sepsis will add to the risk of
infective discitis.
 Renal failure or Cardiac failure
 Multiple myeloma
 Infants (it is also indication if required)
Large disc herniation
Canal stenosis
Disc height loss > 50%

13. CONT…..
 Coagulopathy
 An active infection
 A previous operated on disc (difficult evaluation)
 A solid bony fusion
 Psychological factors

14. Plain Radiographs
Investigations

15. CONTRAST MEDIA
 Non ionic contrast media is used such as Iopamidol
or Iohexol.
 Conray280
 Urograffin 60(2 to 5 ml)

16. EQUIPMENT
 Tilting fluoroscopy table.
 Discographic needles – a set of two needles used for
each level
a) Outer needle , 21G -12.5cm
b)Inner needle ,26G -15.8cm
 Xylocain 4 (Anaesthesia)/bupivacaine
hydrochloride 0.5
 Syringe
 Cotton
 Antiseptic jelly
 Emergency drugs
 Normal saline

18. PATIENT PREPARATION
 The procedure and its aim are explain to the patient
.consent sign is required before the examination.
 Ask the previous history and allergic reaction from the
patient’s.
 Diazepam may however be required in very anxious
patients some authors recommend broad spectrum
antibiotic cover (e.g; Cephalosporins given )
immediately before the examination to minimize the
risk of the infection.
 Usually patient are advised to increase their fluid
intake at the day of the examination.
 Solid food be avoided for several hours before the
examination, but fluid may be cont.

19. CONT………..
 Ask the patient to remove some or all of your cloths
and to wear a grown during the examination.
 You may also be asked to remove jewellery, false
teeth, eye glasses and any metallic object.

20. PRELIMINARY FILM
 Anterior-posterior view
 Lateral view

23. PARTS OF DISCOGRAPHY
 Three parts of discography…..
 Cervical discography
 Thoracic discography
 Lumber discography

29. TECHNIQUE
 There are two possible needle approaches:
a) the posterior approach, which transverse the
spinal canal.
b) the lateral oblique extradural approach , which
avoids puncture of the dura and the vulnerable part
of the posterior annulus.
 The lumber puncture is done at the level of L2-L3;
L3-L4.
 Lumber puncture can technically be performed in
the lateral decubitus position , in the sitting
position , or even in the prone position.

30.  The sitting position allows easy to lumber puncture but is
unsatisfactory for two reasons;
a)the injection of contrast media is drop through a large
volume of CSF to accumulate in the sacral sac.
b)the patient may faint in this position , a complication
that can be very dangerous .
So ,the puncture should be done in the decubitus position.
 The midline position may be verified while introducing
local anaesthesia (1 lignocaine) into the skin and the
subcutaneous ligament.
 The patient’s head resting on a pillow and pad placed in
the lumber angle to maintain a straight spine .moderate
spine flexion is useful, specially at L5/S1.

31.  The operator and any assistant should be gowned ,
masked ,capped and gloved and the patient should be
draped. The level to be examined is determined by ,
usually a hand’s breadth from the spinous process.
 The outer 21-G needle is then directed introduced in the
posterior aspect of the disc under the fluoroscopic control ,
at an angle of 45-60 deg to the vertical.
 The inner 26-G needle is then introduced through the 21-G
needle and the entry of the its tip into the nucleus
pulposus confirmed in two planes with the aid of the
images intensifier prior to contrast medium is injected .
 Contrast medium is injected slowly using 1 ml syringe .
This is done under the fluoroscopic control .
 The resistance to flow will gradually increase in a normal
disc during the 0.5 – 1.0 ml stage.

32.  After injected a contrast media , the patient turns to
lie prone , and the series of films is obtained.
 Before taking the film ensure that the relevant
segment of the intervertebral disc is adequately
filled with contrast medium .
 And after taking a series of film the spinal needle is
safely removed from the disc .

33. FILMS
 Posterior- anterior(PA) view is taken .
 Both lateral view
 Both oblique view
 At the end of the procedure after the needle
removed , PA and both lateral film are also taken in
the standing position .
 Film in flexion and extension may be useful.

42. PATHOLOGY

44. AFTERCARE
 Simple analgesia may be required and overnight
admission is usually advised .

45. COMPLICATION
 Due to contrast :
headache
nausea
vomiting
fever
 Due to technique:
pain
infection
bleeding
trauma to adjacent structure