Hi Harrison,

You bring up two good points. A black disc only means it is dehydrated and most likely behaves mechanically different from a healthy, water-filled disc. But it does not alone equate to pain. I think the painful combination is when you also have annular tears. Then there is a way for the acidic fluid to leak out from the disc. I read that dehydrated discs use a different chemical process to produce energy, which leads to inflammatory proteins as a by-product. If these proteins can leak through the annulus they will irritate the nerves, causing pain.

Some doctors I have spoken to did not recommend discogram, because it does not bring any new significant information (according to them). At least in my case one can clearly see which disc is black&torn-up and which is intact&healthy. I also worry about provoking healthy discs.

Harrison, I see you have been into this subject for a long time, so I wanted to ask you one thing. Do you know any patients with ddd and annular tear and pain for years that have eventually managed to fully heal with conservative methods (spontaneous fusion does not count). Doctors claim they exist, but I am having difficulty finding the evidence. Surely they cannot all be trying to pull wool in front of my eyes?

Nucleus Propulsus as a pain generator
 

I know you weren't addressing me, but I wanted to weigh in regarding your disc with the annular tear. This would indicate to me that the nucleus propulsus is leaking, and this could be your pain generator. The NP secretes a substance that is highly irritating to nerve tissue, and can be a huge pain generator. Even if you don't have obvious compression on MRI, you can still have massive pain from this source.
GC

reference
 

Hi GirlCaptain,
　
Yes, that is the thing that many will miss. There are a lot of articles such as the one you linked. The one you linked is a bit older and pay-to-read. Having to pay to read publications, especially in medical field, is i.m.o. not morally right, but that is a whole different topic to discuss. :)
　
Here is another similar article, a free one:
Intervertebral discs which cause low back pain secrete high levels of proinflammatory mediators
http://www.bjj.boneandjoint.org.uk/content/84-B/2/196.short
　
They find that
"Our study has shown that significantly more IL-6, IL-8 and PGE2 are produced by discs from patients with low back pain compared with discs from patients with sciatica."
　
In fact I don't have sciatica at all, which is quite in-line with this diagnosis. I belive sciatica is common especially for people with large herniations resulting from trauma. A single traumatic herniation may heal in time, but a degenerating disc may be trickier (as I read on this forum people whose condition keep getting worse over the years...).

They also comment on discography:
"Provocative discography is currently the method of choice for diagnosing discogenic low back pain. It is a subjective test relying on the radiologists’ and patients’ perceptions to determine the result.29-36 Many patients with such complaints have associated psychological or psychiatric disturbances which may or may not be associated with medicolegal factors. All of these decrease their ability to give an accurate opinion as to whether the pain produced at discography is that of which they are complaining."

pay to read?
 

Sorry if that link came up as a pay to read site. I linked to the article summary, which I found helpful.
GC

Hi, as you can see I had ADR on L5S1 6 months ago. I'm off pain meds, but still not back to work. I still feel the same pain as before and nobody has a clue why. It could be memory pain, but I hardly believe in it. I had pain stting/standing/lying/walking. But, I never had regrets about the ADR. A black disc won't heal. When you're older (they told me above 60 years) hardly anybody has working discs and they naturally fuse with time. But when you're in pain and you qualify as an ADR patient, I'd go for it as long as you have tried all conservative methods. You wait too long and your facet joints will start to get damaged and then you won't get ADR anymore. At least not from a good surgeon as they know this disqualifies you.

Here's some scientific results on the disc I have.


https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3567327/

I agree with Harrisson
 

The disc can look dark from regular aging...What I would want to see is the view looking down through the top of your spine to see if any nerves coming off the spine are infringed. I have heard that discography aren't always conclusive, but for insurance purposes it may be the first step in proving necessity for any surgery. Then some may want to do a CT mylogram. They may consider doing micro discectomy before disc replacement. Surgeons here with exception:raspberry: of a few will only do fusion. Although some ADR surgeons feel that M.D.'s only prolong what really needs to be done. Keep updating and I pray you find your answer.

Ive had 2 microd's and never had a discogram
I would Never allow a healthy disc to be compromised:chainsaw:

Hi Chris,
I read your story and it is very saddening that you did not get enough help from the disc. On the brighter side, at least it did not get much worse I assume? I really hope your recovery will continue and give capability to work. Even part-time standing,laying,fromhome could help?

I agree fully that waiting is not risk-free at all. It is only risk-free for the dr.

The LP-ESP device sounds very technical and thought has definitely gone in developing it. It is surprising that despite all the work on the elastomer discs, the outcome is not amazing.

In your article, only 59% had 25 % ODI improvement in 3 months. It seems that waiting 12 months gives 82% of patients 25 % ODI improvement. Maybe the one year mark may be the point where many start to feel better.