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Provocative Discogram

What Is a Provocative Discogram?

A provocative discogram is a diagnostic procedure to help identify which disc(s), if any, are causing pain (discogenic pain). The walls of the discs may develop tears (fissures) or the disc walls may weaken and bulge (herniation), both conditions may be a result of age or injury. A provocative discogram increases the pressure inside the disc and may reproduce pain.

The Procedure

Provocative discograms are performed in the office. Patients are required to check in 30 minutes prior to their scheduled appointment time. Once taken back to the preparation area, a small IV catheter will be placed in your hand or arm. This catheter may be used to administer light sedation for the procedure. When taken to the procedure room, you will be placed on your stomach with a pillow under your hips. Blood pressure and oxygen saturation monitors will be applied. The injection sites will be cleansed with an antiseptic solution and draped in a sterile manner. Using a small, thin needle, local anesthetic is injected to numb the skin and deep tissue, which may feel like a stinging and/or burning sensation. Assisted by fluoroscopy (X-ray), the physician is able to accurately place a needle into a disc. Using special instruments, X-ray dye is injected into the disc, causing an increase of pressure inside the disc. In a normal disc, there may be pressure but no pain will be experienced. In a damaged disc, back pain may be reproduced (concordant pain). Through the use of fluoroscopy, any tears, cracks or herniations may be seen. Based on your symptoms and your MRI results, several discs may be tested in order to identify which discs are causing your pain. The procedure will take approximately 60 minutes to complete.

Recovery

Provocative discograms do not treat your condition — they are diagnostic tests that help your physician plan your therapy. Due to the nature of this procedure, you may experience an increase in your back pain for 24–48 hours. You may experience “soreness” of the injection site for 1-3 days following your procedure. Ice may be applied to the affected area for 20 minutes at a time over the next 24 hours. We advise patients to “take it easy” for the remainder of the day. You may perform activities as tolerated.

Once the procedure is over, you will be taken to a recovery area, where you will be monitored for 15-30 minutes and released to go home. You MUST have someone available to drive you home. Failure to have a driver may result in your procedure being rescheduled. You should be able to return to work the next day.

Provocative Discogram Risk Factors

Possible side effects may include:

  • Infection
  • Bleeding
  • Hematoma
  • Pain at the injections site
  • Headache
  • Temporary increase in pain

You may feel lightheaded and/or unsteady; this is usually due to the sedation you were given during the procedure.

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