discogram results

[Shane]

I am trying to make sense and trying to clarify the results of my discogram and MRI reports. I keep hearing different things from different doctors. During my most recent "episode" I had an MRI that stated "shallow buldge disc/minimal protrusion with associated annular tear at L4-L5 but only minimal to very mild reduction of AP diameter." L5-S1 is pretty much gone and has been for a while. During my discgram, no pain in L3-L4, slight to mild pain in L4-L5, and major pain in L5-S1. The surgeon that performed the discogram said that 5-1 is causing 75% and 4-5 has about 25% of my pain . Her report reads at 4-5 that "the saline reproduced that at least one component of the usual pain". She said that I would need a 2-level fusion or ADR. I have since consulted with other surgeon who have given different opinions about results from discograms.

Has anyone been told similiar things? If so, how did you resolve the situation?

[JJames]

Shane,

I truly wish that I could assist you in some way. All I can provide is the fact that you are most certainly not alone. I have come to the conclusion that all of these tests, whether benign or painful, are ultimately left to the sole interpretation of whoever reads them. I have several CDs of all my X-Rays, MRIs, discogram, and other scans which have been performed over these painful years and yet get a different opinion (to some degree) from each of 5 different surgeons who have reviewed them and read the reports.

I struggle with the same issue which you are dealing with. I find myself completely stuck and unable to make a decision regarding surgery. It is so difficult to get a straight answer from any of these so-called experts.

I hope you have better luck than I do. Perhaps there are others on these boards who my be able to offer more beneficial information. In any event, you are definitely not alone in the way you are feeling. Of that, I am all too certain.

Best of luck to you,
Jeff

[Harrison]

Shane,

Here are a few topics which may help you sort through these questions:

Discograms – what should I expect?

Q & A with Texas Back Institute (now four years old, but a few germane points)

Also, if you search the forums (use “discogram” in topic field only), you’ll find 40+ relevant topics.

Annular tears can certainly be a tricky pain generator. Perhaps this same disc could be repaired with newer technologies, e.g., annulus repair, fibrin injections, etc.

If L5-S1 is really shot, I am unsure as to how a minimally invasive procedure like annulus repair could be synchronized with fusion or ADR. That said, MIS fusions have been performed now for some time, if you care to consider that. When is MIS ADR coming?!

There are many variables – as you are discovering. I would get more opinions from experienced arthroplasty surgeons, especially since there are some lingering questions.

[longroadahead]

Have you had your posture and muscle tightness evaulated?

Overly tight muscles and bad posture can lead to a number of problems.

In my case, my pelvis is slighty tilted/twisted and have overly tight hamstrings, calves, etc. which I believe the underlying reason for my disc tears. Doing lots of stretching and PT again to try to get everything back in alignment.

After alignment then am hoping my disc will heal since there seems to be preservation of disc height...

[Harrison]

Good idea, longroad! Actually, a good idea for all of us!

[CharlesinCharge]

Shane,

With all due respect to what LongRoadAhead stated, the major problem with discs healing is that there is really no blood supply to them. Once degeneration starts, it almost always continues, even with good disc height. That is why you can completely tear something like your hamstring muscle and it will heal without surgery (great blood supply) but even a small annular tear will often never resolve (and in fact the disc will continue to degenerate).

In my case, two discs were definitely pain generators and the 3rd one was borderline (like yours). The surgeon decided not to operate on that one, and in retrospect it was a mistake. The 3rd disc continued to degenerate and ultimately became very painful, and 2 years later I was back in the operating room for another spine surgery.

I very much agree with Harrison that you should get multiple opinions, but if it were me and I ultimately did end up having surgery on 1 disc and another one was somewhat painful or borderline, I would definitely "kill two birds with one stone" and get that one replaced as well. The odds of it getting better or the degeneration not continuing are quite slim in my experience, so why not be proactive and get it fixed at the same time as the other one and avoid a second surgery down the road??

Just my two cents,