Discography, lumbar, radiological supervision and interpretation
CPT4 code
Name of the Procedure:
Discography, lumbar, radiological supervision and interpretation
Common Names: Lumbar Discography, Discogram, Diagnostic Disc Injection
Summary
Lumbar discography is a diagnostic procedure used to pinpoint the source of chronic lower back pain. By injecting contrast dye into the lumbar discs under X-ray guidance, physicians can examine and interpret the images to identify problematic discs.
Purpose
Addresses: Chronic lower back pain for which the cause is not easily identifiable through standard imaging techniques.
Goals: To confirm which vertebral discs are causing pain, aiding in the development of an effective treatment plan.
Indications
Symptoms: Persistent lower back pain, pain radiating to the legs, or unexplained back pain after surgery.
Criteria: Patients who have not responded to conservative treatments like physical therapy and medications, or those being considered for surgery.
Preparation
Instructions: Fasting for at least 6 hours before the procedure; avoiding certain medications like anticoagulants as advised by the doctor.
Assessments: Routine blood tests, imaging studies like MRI or CT scans to evaluate disc health.
Procedure Description
- Preparation: The patient lies on their stomach on an X-ray table. The skin over the lumbar area is cleaned and sterilized.
- Anesthesia: Local anesthesia is applied to numb the skin and tissues down to the disc.
- Needle Insertion: Using fluoroscopic (X-ray) guidance, a needle is inserted into the center of the lumbar disc.
- Injection: Contrast dye is injected into the disc. The patient may experience temporary pain, indicating the problematic disc.
- Imaging: Images are taken to observe the dye's distribution pattern and identify any abnormalities.
- Interpretation: The radiologist interprets the images and reports findings to the referring physician.
Tools: Needle, contrast dye, fluoroscopy machine
Anesthesia: Local anesthesia with possible mild sedation
Duration
Approximately 30-60 minutes.
Setting
Performed in a hospital radiology department, outpatient clinic, or surgical center with imaging facilities.
Personnel
Radiologist, nurse or medical assistant, and potentially an anesthesiologist if sedation is used.
Risks and Complications
Common Risks: Temporary increase in back pain, bleeding, infection at the injection site.
Rare Risks: Allergic reaction to contrast dye, nerve damage, disc infection.
Management: Application of antibiotics if infection occurs, medications for pain management.
Benefits
Expected Benefits: Accurate identification of the specific disc causing pain, leading to more targeted treatments.
Realization Timeline: Immediate insights from imaging; long-term impact on treatment effectiveness.
Recovery
Post-Procedure Care: Rest for 24 hours, avoid strenuous activities for a few days.
Recovery Time: Typically 1-2 days for initial recovery, with follow-up appointments to discuss findings and treatment options.
Alternatives
Other Options: MRI, CT scan, physical therapy, pain management injections, conservative treatments.
Pros and Cons: MRI and CT scans are non-invasive but may not show disc pain origins; physical therapy is less risky but may not resolve severe pain; injections offer temporary relief without diagnostic insight.
Patient Experience
During Procedure: Some discomfort or pain when the dye is injected; otherwise, minimal pain due to local anesthesia.
After Procedure: Mild to moderate pain at the injection site; pain management with prescribed medications; short recovery period.