Provocative Discography

A provocative discogram is a diagnostic procedure used to help determine whether symptoms are arising from the intervetebral disc itself (also known as discogenic pain). In most cases this is performed in the lumbar spine, to investigate lower back pain (provocative lumbar discogram). Occassionally it is performed in the neck.

This procedure is carried out by an expert radiologist or interventional pain specialist. A fine needle is inserted (using local anaesthetic and often some sedation) through the skin and into the disc. In most cases a CT scan is done during the procedure to ensure correct needle positioning. Some dye is injected under presssure and this gives us two important pieces of information:

1. Structural information about the disc. In particular, are there any tears or fissures?
2. Information about your pain. If the same pain that you normally experience is felt when one (or two) discs are injected ('concordant pain'), but not on injection of another disc, then it is more likely that you have discogenic back pain.

If you have concordant pain arising from a structurally abnormal disc, then you may be a candidate for either a fusion or, on occasions, an artificial disc replacement (arthroplasty).