Can I ask Discogram from my surgeon

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NotPerky

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My understanding is the discogram is a diagnostic test to pinpoint the area that's causing the pain, so it seems that would be a valid request.

Megss -- I probably wasn't clear on why I wasn't a candidate for a fusion. When the disks are fused, they are immobile and it puts pressure on the other disks to take up the slack, so to speak. Therefore, the other disks must be healthy enough to do so. Mine are not; they are degenerated all up and down my spine. This is why you sometimes hear about pain coming back in other areas after what seems initially to be a successful spinal fusion. The pain goes away right after the surgery; but then the patient starts having problems with other disks....has to have a second fusion, then maybe a third, etc. I was also not a candidate for an artificial disk, for the same reason.

I believe the first surgeon I consulted was willing to "try" a fusion -- but he couched it in his report with "my greatest fear is she won't have any relief of her pain" (!). The second and third surgeons disagreed, thought a fusion was too risky and would cause additional problems. When "surgeons" think surgery won't work, you tend to think twice about it.
 
I have been having spine disk herniation for almost one and half years and right now I still have right leg pain. I did my second MRI in Deceraber 2008 that shows my herniated disk reduced its size a lot.

But when I saw a Neuro surgeon A in March this year, he still suggested me surgery even he saw this MRI, I didn’t accept the surgery at that time.
I did my third MRI in October this year and it shows my disc almost has no change. Then I saw another neuro Surgeon B and he said I don’t need to have surgery at all and can try some medicines since I have tried a lot of non-surgery methoRAB.. So I have tried for one months Lyrica 150 mg/daily but dosen’t help.I will see this sergeon on Tuesday. I think he is going to increase the dosage.
So far I got different suggestions from these two good surgeons for my circumstance.
I am going to ask Surgeon B if he can try to use discogram to determine what is real reason to cause my leg pain. I don’ t know if it is good idea, but I don't think using high dosage medicines is a good method.
I need your advise. Thanks!
 
NotPerky- So what are you suppose to do forever? Will you have to just live with the pain? Can they just fuse everything like they do for scoliosis patients? That doesn't seem right that there is nothing that can be done surgically. SO what are your options right now?
 
Meg, not to hijack the thread, but to answer your question -- not everyone is a candidate for spinal fusion surgery. I was referred to a specialist to manage the pain. It was very depressing to hear there is no miracle surgical cure. However, there's no way I would push for fusion surgery with the risk it wouldn't help or could make the pain WORSE. As you know, it's major surgery with a long recovery period.
 
Megss,

I saw my neuro- surgeon on Nov 18. he said I am not a surgery candidate because he looked at my MRI and believes right now my disc already decreased it’s size and so he think the irritated nerve causes my leg pain. when I asked him why my MRI’s report’ impression said as following,

No significant change in the appearance of the lurabar spine since the MRI of about 9 months earlier. Specifically, the minimal impress on the S1 nerve root origins at L5-S1, the thecal sac at L4-l5, and the slight impress on the right side of the thecal sac and presumably the right L3 nerve root origin at L2-L3 are unchanged.

if my nerve still is impressed and causes this leg pain? he said no, everybody can have this. He is going to give me a injection which likes Epidural, My plan is that I will ask Discogram after injection. If he doesn’t agree to do this, I may see another surgeon. I think if I see two more surgeons . I will obtain two from three people to hold the same opinions.( I am a surgery candidate or not ) I don't know if I have other good method can go.

Thanks!
 
You will find that every surgeon will have a completely different opinion, even if looking at the same MRI. Before my first surgery, I saw 3 different surgeons for opinions. One surgeon suggested a 2 level fusion, one surgeon suggested a 1 level fusion, and the third surgeon wouldn't have done surgery at all. I went with surgeon nuraber 2 and had a 1 level fusion. Unfortunately I chose the wrong surgeon. I am now with surgeon #4 and will be having a second surgery. I should have had a 2 level fusion to begin with.

So you will hear different opinions, but there is only 1 solution. Choose the option that seems right for you. If you are still in pain after trying all conservative methoRAB, then it sounRAB like surgery is what you need to do.
 
I saw my surgeon on Dec 1, he did a injection which is called Larabo/Sacral Facet injection. He said most people will feel some help in 24 hours to 2 weeks. He asked me to call him in two week. I think he may can’t help me if the injection doesn’t work. I feel so far I have no any different after injection , I guess that is it even wait two weeks.
I am going to ask him to do Discogram or referral someone to do it for me. The reason I want to do Discogram because I think even my disc right now just “ slight impress “on my nerve, It still can cause my leg pain. so I hope the discogram can bring a new proof to show my surgeon. Maybe he will change mind and have another idea. If my guess is correct, surgery maybe still is my option.

Thanks!
 
Ah yes I am all too familiar with how horrible of a procedure it is. I am so sorry there is nothing that can be done for you other than managing the pain. I should have had 2 levels fused to begin with. I had L5-S1 fused and now L4-L5 has gotten even worse and L3-L4 and L2-L3 are beginning to tear. When I saw the surgeon earlier this month, he explained to me that I would 99% surely need an additional surgery, but he ordered a discogram and a CT to be 100% positive. The doctor who did my disco and saw the CT straight up told me that yes I need another surgery. I see the surgeon Dec 1st to schedule surgery, and I am terrified that he will want to do something with L3-L4 and L2-L3 in addition to L4-L5. To make matters worse I am having my gallbladder removed in 2 weeks. I have been advised by my GP and gallbladder surgeon to do it now before my next back surgery so I don't develop pancreatitis or something while I am trying to recover from major surgery. This year I can't catch a break!
I wish there was something they could do for you. I am holding out hope that someday I will be pain free, and I wish that for you as well.:angel:
 
Efang- I would absolutely request a discogram. They are very accurate tests that pinpoint the source of your pain. They aren't any fun to go through, but worth it so you can have the correct treatment plan.
 
Efang, a couple questions -- have you had epidurals? Has your pain lessened with the reduction in size of herniation? Don't jump into surgery. I did (after having epidurals, anti-inflammatories, etc.), because I assumed it would fix the problem. It didn't. I still have the same back and leg pain. My surgeon said the next step would be a spinal fusion. I went to a top spine surgeon in a large city, who was going to do a fusion, though there were no guarantees I'd be pain-free. He was out-of-network for my insurance, so I went to another top spine surgeon, who ordered a discogram. He then told me I was NOT a candidate for spinal fusion, because all my disks were de-generated (i.e., the disks were not healthy enough to support the fused disks). So then I was REALLY confused! I had a third doctor, this time a neurosurgeon, do a tie-breaker opinion. He agreed with the second doctor. I am in severe pain, but I was told the pain could actually be made worse with a fusion....so I passed and am trying to deal with the pain.

My point being -- yes, these surgeons can all have different opinions. But find the best orthopedic and neurosurgeons you can, and try everything you can before resorting to surgery. It can be a slippery slope.
 
I saw my surgeon 12/22, I asked him if I can do Discogram to find out there is real reason to cause my pain. He said Discogram is a very painful , which neeRAB to inject a kind of dyestuff to see which area in my spine is "leaking " (I don
 
Yes a fusion is definately not something to jump into, try all other options first. A fusion is a major major surgery and is very painful. It takes a year to recover from that. I had L5-S1 fused 7 months ago and have never felt better. A recent CT said it is not healed yet. I am worried that it failed. I now need L4-L5 fused, and I am hoping that will solve my problem or at least give me some relief.
Not Perky- I wanted to comment about that surgeon who said you are not a candidate for the surgery. That makes no sense to me. When I had my surgery, he took out the L5-S1 disc completely and replaced it with a chunk of donor bone. The idea is that it will all fuse together in one piece. I would look into seeing a different surgeon personally.
 
NotPerky and megss,

Thank you for your reply. Now I answer your question,
1) I have had three times epdurals
2) My pain almost have no lessened with the reduction in size of herniation. The pain rate is about 3-5. it is not severe and locates in my calf area. My back pain and leg pain started at same time, my back pain lessened pretty soon after treatment ( about 2 weeks) , but my leg pain almost just have no changed for 18 months. My personal feeling right now my leg pain is not caused by my herniated disc and have other reason, so that is why I like to try discogrem.
3) I will not concern about fusion even I need surgery, I only can accept minimally invasive surgery.

Thanks!
 
Hi defang622,
A good candidate for a discogram is anyone contemplating back surgery.
Usually a discogram is perfomed by an anetheseologist/pain management MD
Its painful when they "hit" the right spot...the level that gives the pain is the indicator of that level in your spine that has a problem. The pain is temporary ...goes away pretty quickly when the needle is removed but the informatoin is invaluable in determing where your pain is originating from.
 
A discogram is painful "in the moment". I had one recently on L1-2, L2-3 and L3-4. At the moment they are testing the disc it is sharply painful. But often they give IV versed which is a sedative that keeps you awake and aware but helps you forget the pain. During a discogram the doctor has to see if he/she can re-create your pain. I will say that I was sore for 2 days after the discogram but not bad at all - felt sort of like a big bruise was in the area (there was not but it just felt like that). They do inject dye to do the test and they often follow up with a quick CT scan so they can see where they dye settles, if any leaves the disc which also may show damage, etc.

Pain Management doctors do discograms as do some Neurosurgeons and Orthopedic Spine Surgeons.

If they have other test results that show definitively where the damage is (i.e. MRI, CT, CT myelogram, x-ray, etc) and the results they see on these tests matches with the symptoms you have, then they may not want to do the discogram. In my case it was just one extra step before my L3-S1 fusion in February 2010 to figure out if L2 should be included.

Keep in mind that a discogram is an invasive test and some findings show it can compromise the disc. So it should be considered but not always encouraged as not need to invade more than needed.
 
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