Diagnostics

Discography

Discography (An x-ray of the disc after dye is injected into the disc) allows the physician to more accurately diagnose and treat many types of spinal pain.

The intervertebral disc is now recognized as a common source of chronic axial pain. Irritant chemical substances have been identified within the disc that could cause sensitization of the disc annulus to mechanical loading. The pressure controlled diagnostic discography with digital manometry is able to predict surgical and nonsurgical outcomes. This formal discography diagnostic categorization system has been introduced by Richard Derby with a view to facilitate more precise and specific discography  diagnoses. With increased use of pressure controlled manometry it becomes possible to measure accurately the incremental injected pressure and the resultant pain elicited. Consequently, the level of disc sensitivity can be classified and categorized accordingly resulting in more precise diagnoses and predicted surgical outcomes.

The test is safe and carries only a minute risk of infection. Some patients will experience mild back and irritation from the dye for a few days. The information that the test brings is well worth the minimal discomfort. Additionally, this test may be the only positive finding when all other diagnostic tests may have been read as negative.

Fluoroscopy

USE OF FLUOROSCOPY IN PAIN MANAGEMENT PROCEDURES

The efficacy of any nerve blocks or other pain management procedure depends on:

1. Proper Patient selection.

2. Adequate localization and placement of the medicines in the affected area.

Use of fluoroscopy ensures accurate and proper placement of the needle in the space where it is intended to be. In addition with confirmation of the location of the tip of the needle the injection of the medication intravenously or in other spaces where it is not intended is avoided, thus preventing side effects and complication of the pain management procedures.

Epidural steroid injections are the most common procedure for pain management. There are studies to indicate that in the most expert hands epidural done without the use of contrast or fluoroscopy can lead up to 25% of patients in which there is improper placement or improper localization of the epidural space. In addition, one can have either subperiosteal penetration, suprasacral penetration which might be common especially for caudal epidural blocks. The confirmation of proper diffusion pattern utilizing the dynamic fluoroscopy and contrast medium is important for adequate localization of the injectant.

In summary, the use of fluoroscopy in pain management is the most cost effective safe and efficacious method of delivering intended medications. The use of fluoroscopy and contrast medium with subsequent physician interpretation should decrease the patient morbidity and improve the efficacy of procedure and is an accepted method of practice

References:

White, A.H. Epidural injections for the Diagnosis and Treatment of Low Back Pain. Spine 1995; 78-86.

Renfrew, D.L. Correct Placement of Epidural Steroid Injections Fluoroscopy Guidance and Contrast Administration. AJNR 1991; 1003-1107.

Schellhas, K. Epidurography and Therapeutic Epidural Anesthetic and Steroid injections. International Spine Injections Society, 1992; vol 1 #4; 2-4.

CPT Testing