Provocative discography or discogram could be performed in the cervical or lumbar area in order to see if the intervertebral disc is the primary pain generator. This procedure is usually performed after the treatment of the facet arthropathy and radicular pain if present. Discography is the last diagnostic approach for the patient before a surgical evaluation and should be performed after at least diagnostic blocks are performed to assure that other structures are not the main pain generator for the patient.
The procedure is performed by injecting contrast material into the nucleus pulposus of the intervertebral disc (center of the disc). Patient usually is provided with intravenous antibiotic prior to the procedure to prevent infection. Pain is produced in the abnormal disc due to intolerance of increased intradiscal pressure or contrast material leaking through the walls of the injured disc. The patient is asked whether he or she feels pain vs. only pressure sensation first. The feeling of pressure only confirms that this particular intervertebral disc is not the main generator for the pain. If patient reports having the pain with the introduction of the contrast material into the intervertebral disc, the pain needs to be specified whether it is a concordant pain ( resembling the typical daily pain for the patient and more intense at that moment) or a different new pain. The existence of the concordant pain confirms that injected intervertebral disc can possibly be the main generator for the pain.
The cervical or lumbar discogram procedure primarily serves as a prerequisite before performing a minimally invasive procedure or surgery.