discogenic pain, results

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steveadams

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hi all, new to this forum, and im glad i found it.
i have a question for people who might understand what all this means,
i have a report back from a discagram which reaRAB,
with the patients consent, under fluoroscopic guidance, injection of the degenerative L4/5 and L5/S1 disc was performed.
L5/S1 1ml of contrast injected. pain severity 7-8/10 and almost similar (7-8/10) to the usual pain.
L45 1ml of contrast injected. no significant change in the pain following the L5/S1 disc injection.
L3/4 attempted injection of the L3/4 disc as a control was performed. the needle was positioned at the margin of the disc, however, it was extremely painful to penetrate annulus and the injection had to be abandoned.
CONCLUSION concorant pain at L5/S1. injection of the L4/5 disc was not conclusive and no control could be obtained. suggest inclusion of the L4/5 disc if surgery is considered.
now what does all that mean.
any help would be nice
 
A discogram determines what disc is responsible for the pain. Your disc L5-S1 showed a pain response as 7 to 8 out of a possible ten and mimiced the pain you experience. When they tested L4-L5 you did not experience pain relief so they think that level may be involved as well. They try to test another good level as a control for comparison but were unable to do so. Only a layman so ask your doctor about results.
 
Usually one of the main reasons for performing spine surgery is to decompress a nerve. The compression of the spinal nerve, or the irritation of it is one of the main reasons for pain and sciatic-type pain that runs into the buttocks and down the leg. Sometimes the thing that is causing the compression will go away from conservative treatments, such as anti-inflammatory medications or injections, but under other circumstances the only way to release the nerve is through surgery.
 
thanks again for the replies, so surgery looks likely then, or will the doctor opt for another test.
i'v had epidural, facet joint injections, anti inflammatory pills to the point i now have stomach ulcers and cannot take them now, so coz i am private patient i feel they just want to rack up a big bill, maybe its just frustration from hurting all the time and sleep lose
 
thanks for that, i cant see the doctor now till feb,
so does it look bad for me, i mean what level of operation is needed
 
Hello Steve. I would suggest getting a second opinion. Since your dr. is a neurosurgeon, perhaps you could look for an Orthopedic Spine Specialist for the 2nd opinion. I have to say that I question your surgeons statement that the trapped nerve will "unwrap itself". That would be unusual, especially if the bad disc itself is pressing on the nerve.

It does seem that you should have more testing, perhaps an MRI or ct scan with contrast to determine why that nerve is being pinched. I think most doctors in this country would do that before ordering a discogram as that test is so much more invasive. My surgeon believes they should be done only if other testing is unclear.

At any rate, getting a second opinion is very important. Surgery should be done only if there is no other way to help and unless you have a long history with your doctor, a second opinion can be most helpful. At least, that's my opinion.

I hope you will stay in touch with us and let us know how you are doing.

Carol
 
From what I experinced was similar to yours.. My MRI showed DDD at l5-s1 and to confirm that was the disc of the pain source from IDD a discogram was ordered.. I had 3 levels checked at l3-l4, l4-l5 and l5-s1. The 2 disc was a control disc and to confirm the l4-l5 was good enough to hold a fusion at l5-s1 which was confirmed.. The l5-s1 was the only disc that replicated my usual pain.. I almost jumped off the table when it was injected. He immediately stop the injection and put lidocaine in to try & nurab the disc somewhat and finished by putting in anicef to help with possible infection.. I did have a CT right after and it did show tears which I knew b/c the doc who done my discogram had showed me the fluroscopic image after the discogram.. I met with my neurosurgeon 12-29-10 and he said since the discogram was positive he would suggest surgery.. I decided on the TLIF min invasive b/c its done from 1 side of the disc with the facet being trimmed to expose the disc for discectomy and the facet bone is used for implant to use with BMP to not disrupt the hip bone for grapht.. A cage is inserted and 4 pedicle screws with roRAB hold the cage and aloow stability for the fuse to take place.. My surgeon really wasnt concerned with the CT images but mainly the fact there was discogenic pain at the l5-s1 level that is chronic with sciatica mostly in the buttocks and thigh area.. I have had all the shots, therapy, meRAB etc and hes the 3rd opinion that I had.. Surgery should be the last resort unless its debilitating pain or loss of bladder and bowels.. My surgeon is highly regarded where I live and affiliated with NFL team and Nascar teams here locally so I trust his advise and comfortable with my surgery thats 1-27-11.. I hope everything goes well for you and I would see more than 1 doctor if I were you just to see your options!!!
 
thanks for that, sorry i didn't mention i have had a mir, the discs are black and the nerve looks trapped, i will ask when i see him what surgeon he is
 
thanks for the reply, i might have to see another surgeon then,
the doctor at the moment doesn't seem to want to operate, although i haven't had a cat scan yet.
when i look at the mir i can see two dark discs and a trapped root nerve, apparently theres nothing can be done with a trapped nerve, he said, it should untrap its self ?.
so it looks like surgery then, or will they make me do another test
 
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