Cervical Discography

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August 15, 2012
Edward Smith

Cervical pain rivals low back pain as the number one type of spinal pain injured people can have. It is a particularly annoying pain as it can lead to headaches, neck pain and pain along the exit route’s travel, which, in the case of the neck, is usually in the upper arms.

Cervical pain can be caused by many things. In most cases, it is the result of musculoskeletal pain or ligamentous pain in the cervical area. In some cases, there can be damage to the disc so that pressure is put on the spinal nerves, leading to referred pain to the neck, shoulders or arms. The discs are soft, cushiony pads that separate the hard vertebrae of the spine. The disc can bulge into the spinal canal, pushing on the spinal cord, leading to distal pain. It can also tear or degenerate causing localized cervical pain.

The gold standard for assessing the status of the discs is the MRI of the spine. Some people can have a CT scan or plain x-ray of the spine but these are less helpful. Cervical discography is a great adjunct to the MRI scan and works well because it can tell if a damaged disc is the source of the pain. There can be several damaged discs and the doctor may not always be able to tell which one is the cause of the pain. To make matters more complicated, the more damaged looking discs are not automatically the ones causing the pain. It all depends on the cervical discography evaluation.

The cervical discography exam is able to confirm or deny that the disc is the cause of the pain. It is actually a very straightforward test. The area of the cervical spine is numbed with local anesthesia. Sedation is not used because it may hide the pain at the time of the procedure. A small needle is inserted into the disc and the disc has contrast dye injected into it in order to pressurize the disc. If the pain is reproduced exactly during the pressurization, that disc is the likely source of the pain. If there is no pain on pressurization with contrast dye, or if the pain is in a different place or of a different quality from the typical pain, this would mean that the disc being pressurized is not the cause of the pain.

After the test is over with, a CT scan of the disc is done using the contrast in the disc to further outline the shape of the disc and the presence of tears or other abnormalities of the disc. This makes cervical discography a functional test that can subjectively tell the doctor where the offending disc is located. It could mean that a patient is going to need surgery, such as a spinal fusion to eliminate the source of the disc problem.

During the procedure, IV antibiotics will be given in order to prevent infection in the disc, and relaxation medication can also be given. For cervical discography, the patient will lie on his or her back. This is different from lumbar and thoracic discography, in which one lies on the stomach. X-ray guidance will be used to locate the disc, which is entered after putting antiseptic and analgesic agents on the skin. The procedure generally takes one hour or less. The CT scan is done immediately after the test. A person should not drive and should limit daily activities for a day after the test and should expect neck soreness for 2-3 days after the test.