Another Discogram Qu

I know this is a pretty common topic and I�ve looked through various posts and Q & A�s but I would still appreciate some further input. I had my first discogram on 31st August which produced concordant pain and a diagnosis of a flat degenerate L5/S1. The consultant offered me fusion or ADR. I went for a second opinion because my first consultant wasn�t very forthcoming when it came to discussing the options. This led to another discogram under slightly different conditions and with very different results. The first discogram was done from the right (most of the time the sciatic pain is on the right side � although the back pain itself is on both sides) whereas the second one was accessed from the left. The first test led to unbearable sciatic pain. The second one was painful but not unbearably so and led to pain shooting up through my left hip and into my left buttock � not my leg. I frequently get pain in my hips and this has not gone away since the discogram 2 days ago but I�ve never associated it with the disc so I said that it wasn�t �normal�. Now I�m not so sure! Has anyone found that accessing the disc from another side makes a difference to the pain response? It might not be the reason for it at all but I�m struggling to make sense of the different results.

Gillian - the only thing I can add to this is that I had 2 discographies in the UK, both 'inconclusive'. It appeared that I had a septum like division in the disc and so I thought it would be vital to go in from the side where I felt most pain.

When I went to Munich I made a big deal of the fact that my pain was primarily on the right and they should be sure to do the discogram on the right too. But Dr Zeegers told me that it would make no difference which side they go in from.

Perhaps more importantly, he also told me that the referred pain is not the relevant pain - it was the back pain that he was interested in - how much it hurt at the site, when he injected the disc - and boy did it hurt!

I was never told that at home so perhaps that's why the results were inconclusive. At the AlphaKlinik they were stunningly conclusive!

Good luck

Vicky

Hi Vicky.
It's interesting that you were told it didn't matter which side it's done from. I suppose I'm probably just grasping at straws because I don't want to go back to know having a clue what's causing the pain. I certainly didn't expect to get more confused after the second one because I'd been told the first one was conclusive.

I think it was the disc that hurt the first time (as well as having the sciatic pain during the test) because I couldn't lie on it or sit up with it against the trolley in recovery. I couldn't even cough afterwards without making the pain worse in the area where I think the disc is. This time it wasn't anywhere near as painful in that area. It still feels strangely swollen though if you know what I mean - more of a pressure feeling than a pain where the disc is. It's hard to explain!

Gillian, I don't know if my 2 cents will help but I have had 3 discograms. All done by the same doc. The first 2 I was sedated so much all I remember is the horrible pain when he injected my bad disc. this last Aug. I was awake and remember it all. I had pain that went down my leg to my foot when he injected 5-S1. the pain in the disc (back) was off the charts but the fact that I felt pain in my foot too at least tells me that the foot pain I am having now is from the disc itself and not an impingement which makes sense as I still have reasonable disc height. It is not uncommon to be very sore for several days after a discogram. I even had such bad foot pain at times it felt like my foot was broken.
Good luck figuring things out. It is it possible for you to go to Germany? Atleast it is a whole lot closer for you than for us US folks GRIN
Leslie

Just in case anyone finds it helpful, I saw my consultant yesterday. He said that he does want to do another discogram because, having looked at the pictures from the first one, he thought that he hadn't got the needle in far enough. When he pointed it out I could see what he meant. He said it's also possible to have a delayed reaction and that the recurrance of my usual symptoms later that day and during the following days (in addition to the weird left hip pain) also makes him think that the problem probably is the L5/S1 disc. So it's round 3 for me.

Incidentally I've also seen the consultant who did the first discogram and he said he was convinced by it's results and is still confident with his decision to offer me fusion or ADR.

At least things are looking a bit less uncertain.

Gillian, I thought you might be interested in the way my last discogram was worded. You mentioned that the one consultant said he thought maybe he didn't get the needle in far enough...
This is just an exerpt from the report: "I then injected L5-S1. It immediately appeared as if I had an annular injection. This did cause significant pain. Accordingly I repositioned the needle to get a more central postition." It goes on a while and I don't need to type the rest. I wonder if the guy who did yours only got the outer part which would be the annular part of the disc.
I don't know if this helps but thought it would be of interest. Do the folks there do these under xray so they see it at the time too or just pictures to look at after?
Hope you can get some answers!
Leslie

Since another person is bringing up the subject of discograms...i've always wondered whether everyone has horrible pain after a discogram regardless of whether there is a problem with a disc or not. And when I say "after" I mean after the sedation wears off and you need serious pain meds just to roll over in bed kind of pain following a disckogram. Does this question make sense?

[Mariaa]

I've had 2 discograms to date. Done by diff docs. One didn't do the L5S1 disc as he said he knew it was shot already, and the 2nd doc did.

First one was concordant for pain in L3, 2nd one not. Both for L4 and L5S1 on 2nd one was most painful ..

After first discogram had increased back pain for 2 days, 3rd day decreased and then I felt actually better for about a month.

2nd discogram at the end I asked for an ESI kiddingly and the doctor was kind enough to inject Marcaine afterwards which made my after effects much more gentle in terms of pain, altho I did have it pretty intensely on 3rd day after (as I felt so well by 2nd day after I was walking for about 3 hours and carrying some heavy parcels uphill in San Francisco back to friend's I was staying at)...

My OSS wants to do disco # 3 and I'm reluctant as he's the one that produced the L3 concordant pain altho I do also wonder about technique and placement in terms of reproducing a painful response..

While doing a little medical research I stumbled upon an article describing a delayed onset of pain following discography which meant that in some cases...with perhaps a smaller tear, the patient may not complain of pain during the actual procedure and may not feel it until after they've been disharged, which also means that the dr could miss the diagnosis without proper follow up questions.

Anyone hear of this? Anyone have severe pain only after they were home from the procedure?

I wonder because earlier in this thread I asked if anyone had more pain after being discharged than during the actual procedure. For me, during both discograms, I felt the burning type pain in buttocks/hip/low back area. But once I got home, and had walked around a bit, I felt the disabling -cant move or walk kind of pain...like I might get when over doing it with too much bending, exercise etc.

I am just curious if there are others with similar experiences. I believe my tears for 2 levels of disc problems, are grade 2 and 3. I keep reading about so many people wanting to jump out of their skin during the diskogram but no one discusses how they feel hours after a diskogram.

[Mariaa]

Hours after discogram #1 (L2, L3, L4) Concordant for pain at L3, L4. L5S1 wasn't injected as surgeon said that he knew that level was bad and didn't want me to be in too much pain afterwards.
So that day after procedure, I was in bed with an ice back to low back and very much unable to do anything other than lie around in pain. It was so much like the pain I would have after my back "went out" that I was used to it and just waited for it to level off.. so first day after discogram I still had significant amount of low back pain, 2nd day less, and by 3rd day I was out, 4th day back to work (standing at work station 8 hours for telephonic triage nurse position).. and for a month later I was better than I had been in quite some time. I thought hydrating the disc may have helped..

2nd discogram, (L2,L3/4,L5S1) concordant for pain at L4,L5S1 and asked for ESI afterwards since needed to travel cross country w/i few days so was injected with Marcaine and had much greater relief immediately afterwards and for that remaining day which I spent lying down with ice packs to low back. Next day, was up half day, in bed half day, 3rd day out and about San Francisco shopping, walking uphill inclines, 4th day, sorry I had done so and resting again, 5th day, flew from CA. to Fla. (always purchase 3 coach seats to lie down on)... was ok after this time until next back flare up~