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Take One Discogram, and Call Me in the Morning

Surgeons at the Hospital for Special Surgery in New York City report five cases of an unusual problem after lumbar discography. After the procedure there was a new herniated disc or an increase in the size of a herniated disc already present for all five patients.

Lumbar discography or discogram is a way to show if the patient's pain is coming from the disc. The exact disc level is also identified. During discography a needle is placed into the disc. A small amount of contrast dye is injected into the disc.

A CT scan is taken right away. The scan can show any place where the dye leaks out of the disc. Dye outside the disc means there's a tear in the outer covering (annulus) of the disc. The opening allows the inner disc material (nucleus) to protrude or herniate.

In these five cases symptoms were much worse after the discography. Repeat MRIs showed disc leakage or new fragments of disc not present before the discogram. This occurs when the pressure of the injected dye damages an already weakened annulus. A small tear can become a large tear. A piece of the nucleus can get pushed out. This is called a discography-induced herniation of disc material.

The authors conclude that tears or damage to the annulus can put patients at risk when having a discography. Symptoms can get much worse after the discogram. A repeat MRI is advised for any patient with increased back or leg pain or new neurologic symptoms after discogram.

References: Ashley R. Poynton, MD, FRCSI (Tr & Orth), et al. Discography-Induced Acute Lumbar Disc Herniation: A Report of Five Cases. In Journal of Spinal Disorders. April 2005. Vol. 18. No. 2. Pp. 188-192.

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