Upcoming discogram....

[Tatonka_usn]

Greetings all!

It's been a while since my last postings, and I just wanted to take a moment to extend my warm regards to everyone here. Getting ready to undergo my first discogram (lumbar) this coming Friday (30 July) and wanted to see if anyone has any sage wisdom to pass along in preparation. While I've read quite a number of descriptions throughout the forum, I must admit that nervousness regarding the procedure is starting to creep into my noggin'. I know that this is a necessary part of the process, and certainly has its merits, but the cynical/"glass half empty" part of me worries about the potential risks. Am I just psyching myself out, or is there legitimate cause for concern? Guess I just needed a sounding board from folks who understand....

Thanks!
Alan

[Harrison]

Hey Alan, thx for posting. You may have already seen this FAQ on discograms -- there's a lot of good insights therein.

Also, please note that at SAS presentations this year, Lotz et al discussed using MRS as a diagnostic instead of discograms. I'll see if I can find it, as it may help spine patients avoid discograms in the future. In the meantime, this may be a helpful reference, though not a bulls-eye:

Quantitative magnetic resonance spectroscopy in th... [Magn Reson Med. 2008] - PubMed result

Note that MRS allows doctors to obtain biochemical information about the soft tissues in and around the spine; e.g. the health of a spinal disc. Using algorithms designed to assess spinal disc health, or the degree of DDD, the MRS can assess the “chemical signatures” of lactic acid, proteoglycans and more. With these assessments, they can reportedly diagnose the patient as negative or positive for discogenic pain. Cool, huh? Sure beats a needle in the back…

This is a very significant innovation as most patients get MRIs any way. So this diagnostic potentially replaces the discogram, saves time and money, and is proving to be as accurate as discograms. More on this later, as I am sure there will be questions...

[Tatonka_usn]

Harrison.....wanted to thank you for the input. Had seen most of the threads before, but it was nice to review them.

As noted, I had the discogram yesterday. It went surprisingly well. Asked the doc about sedation for the procedure (versed, etc), but he nixed that idea. So, it was wide awake for me.

As much as I'd worried myself in the days prior to the discogram, I was pleasantly surprised that it wasn't the boogie man I'd feared. Ironically, the most pain I had came from the preventative antibiotic shot they gave me in the keister prior to the procedure (unwelcome memories of boot camp....D'oh!). I had a fair amount of pressure as he inserted the needles, but nothing horrible. When the dye was injected I felt NOTHING. No kidding, he re-ran it a couple times to make sure, but there really wasn't anything notable to report (maybe a slight increase in pressure). Can't say whether this may have been skewed by the fact that my butt hurt SO BAD (no kidding), which covered part of the area I normally feel the sciatica pain, but I could only report what I felt. Any chance he could have "missed" the proper location?

His down and dirty feedback was that, as expected, I have an annular tear at L5/S1 (no suprise, as this is where I've re-herniated). He gave me an all clear on L-3/4 and 4/5 and, interestingly, advised that my loss of disc height at 5/1 wasn't all that bad. I'm a bit perplexed by this, as I've had quite different opinions from several other docs.....guess I'll chalk it up to subjectivity. He also sent me to the radiology clinic downstairs for a post-procedure CT scan to grade the annular tear, but I won't get results back until next week.

So, where does this leave me? Guess I'll take things in stride for the time being and see how I recover from the procedure. I'm fairly sore today across my lower back, but that was to be expected. Beyond that, I've got a new stretching/core strengthening program (began during my last PT appointment under TRICARE), and will probably continue with prolo sessions every month or two for the time being. I still get the feeling that this is gradually deteriorating, and that ruling out discogenic pain doesn't mitigate the reality that my nerves are being compressed mechanically (ie from the stenosis and bilateral disc herniation). Given the fact that I can't get on straight answer/plan of action for this, I'll deal with it the best I can over the short term.

Anyhow, just wanted to thank everyone here again for their support, and extend my warmest wishes for positive outcomes to all.....

Alan

[Tatonka_usn]

Was curious if any who has had a discogram suffered long term symptoms associated with the procedure? I had it done 3 weeks ago and, as mentioned, the discogram itself was essentially painless. That said, I've had an increase of LBP, both across the back and into the right side/buttock area (raditating around into the upper anterior thigh). I'd been symptomatic in this area previously, but the pain now seems to be somewhat more pronounced. It feels more "stabbing", than diffuse, and appears centered in the approximate area of the needle insertions. Not sure if this is 1) in my mind, 2) a function of continued deterioration, or 3) a result of the procedure. It's a bit disconcerting, as my deterioration has seemed to stablize before having the discogram, and I gave serious thought to cancelling. Now I'm wondering if I made an unwise choice, and if the 2nd order effect will be negative. I'm probably just worrying myself too much, but it really has had an impact on my gait, and doesn't appear to bode well.... Any thoughts/feedback would certainly be appreciated!

Best regards!
Alan

[Slackwater]

Originally Posted by Tatonka_usn

Was curious if any who has had a discogram suffered long term symptoms associated with the procedure? I had it done 3 weeks ago and, as mentioned, the discogram itself was essentially painless. That said, I've had an increase of LBP, both across the back and into the right side/buttock area (raditating around into the upper anterior thigh). Alan

Yes, symptoms appeared to increase 7-14+ days after the discogram becoming milder at 21-28+ days. The metrics were recorded patient notes and recorded drug usage.

It's hard to tell if symptoms and the discogram are (were) related because of the variable nature of LBP and sciataca.

Good news you have disc height @ L5/S1 (!). Where was the discography performed? Did you go to UCSF for the discography ??

[Slackwater]

Originally Posted by Slackwater

Did you go to UCSF for the discography ??

2010 ISASS Annual Meeting (was SAS)


LINK
Abstract: 126 Modified Magnetic Resonance Spectroscopy for the Diagnosis of Painful and Non-painful Lumbar Intervertebral Discs

J.C. Lotz1, D.S. Bradford1, J. Peacock2, S.S. Hu1, J. Claude2, S.H. Berven1 1University of California San Francisco, Department of Orthopedic Surgery, San Francisco, CA, USA, 2Nocimed, Redwood City, CA, USA


also:

Lactic acid and proteoglycans as metabolic markers for discogenic back pain
Keshari KR, Lotz JC, Link TM, Hu S, Majumdar S, Kurhanewicz J.
Spine (Phila Pa 1976). 2008 Feb 1;33(3):312-7.

[Tatonka_usn]

Very much appreciate the feedback, Slackwater. I actually had the discogram done in Fairfax, Va....as that is where the family and I relocated in January. TRICARE referred me out in town to a pain managment clinic, and the Doc I saw there decided the discogram was the right way to go. I had reservations, but figured that I was going off TRICARE shortly after (as I left the active duty Navy), and that they could pick up the tab if it was worth having done. I even touched base with a close cousin of mine, who is a very well regarded pain management doc in the Va Beach area (she does alot of work on my back, off the books), inquiring as to whether this was worth my time. She indicated that it would only hurt IF I had a bad disc.

Now that I had the procedure, and relayed the findings, she gave me the "I told you so", and that I really didn't NEED the discogram (THANKS for that, AFTER the fact...D'oh!). So now I'm just taking it day by day. I'm hoping that nothing significant/negative was done, and that this will fade now that I'm approaching the 4 week mark. Note to self....always go with gut instinct....