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Please visit the complete blog entry and PHOTOS here: http://mrdjw.spaces.live.com/blog/cns!33B43BC384EEBA!222.entry -My complete "MAST TLIF Double Fusion" blog is too much to keep up in both places.
I'm no expert, but between average folks...In basic terms, it's a way to take an image of what is going on inside the actual disks. CT Contrast is injected into the nucleus of a normal disk (for the control part of the experiment), any of the suspect disks, and then a CT is run to reveal the fluids location and flow. From my transcribed results, I can tell you they measure pressure, ability to hold pressure, and pain response when pressure is added. Yes, it's a provocative test. Yes you are awake. Yes they might touch a nerve. And Yes some of the pain response is subjective, but as long as the patient is fully participating, it seems quite helpful for identifying "DISK SPECIFIC PAIN" - Meaning, it defines if the disk itself is actually suffering from pain. -This test is often done as a precursor to surgery, but was done a little more diagnostically for me.
Very often, the long needles used to reach the disk nucleus may lightly touch a nerve as they enter the space. This is almost unavoidable some times and there's little they can do but back up and try a different angle. **When it happened to me, it felt much like when the dentist pokes a cavity, but much larger. In fact...It gave me a new "10" as my basis for comparison on the pain chart. -Don't be scared away, just know it may happen and look forward to the excellent data this test can give. I will add, if you go in for a steroidal injection and you tell them you've ha d a diskogram, they usually respond with "Compared to that, you won't even be bothered by what we're doing today!"
They put the needles in (you're blind to the whole thing) and then they start asking questions. Because you don't know which one they are working on, it's fairly truthful when you give them a pain response. However, I was told that some people test positive for pain on even the control disk. My feeling from how it was said, and my report, was that if you have no pain on the control disk, and strong pain on the suspect disk/s.... then we have a strong concordance and confirmation for the source of some if not most of the pain. If the pain one feels in the diskogram is similar to the everyday chronic pain... then we discuss how much of our pain is "that exact pain..." If the "Disk Pain" is more than 90% of your total pain, then it's the usual conclusion that removing the disk/s will greatly help *As it did for me.
Removing disks means Fusion or Disk replacement, but my surgeon told me the disk replacement biz might be phasing out due to lack of solid results. (I read in a popular science mag. -There are technologies like a 3D printer for organics where they've replaced a disk in mice, but are very far off)
Note: they don't' do this usually, but they can inject some steroids into the site at the end to help with pain.
I'm going to be honest here, but don't want to scare anyone off. This test was the largest and best bit of information we had as my injury was purely disk related. There seems to be no other good test for disk pain.
I was quite nervous knowing it would hurt and I had to be awake to report on the feeling. (In the past, I had an LP done to test for one of those mosquito spread things and ended up with a 5 day spinal headache. (Look it up, the worst headache you will ever have and nothing helps it but stopping the leak of spinal fluid)) Pardon, to continue; It was treated like back surgery as far as risk for infection. Which is why they won't perform this more than once per incident even though it allows them to inject some pain relief.
After checking in, I was interviewed by the Doctor performing the test while the nurse put the IV in. The Doctor was missing fingers on one of his hands and had two toes transplanted instead! (Needles, nerves, very precise procedure) But after thought, I came to the conclusion that he is probably the best guy in the world to do this as he has probably had to do a lot of training and testing to be a surgeon/radiologist in this condition. He was a truly wonderful person and I had total confidence going in.
Once in the room, there were a total of 5 people maybe more inside and it was dark with huge screens for the fluoroscopy. I was put on my stomach and my arms were tied down. The nurse who helped me from the start administered a light sedative and became my personal caretaker. Then the test began.
After the initial pricks of lidocaine and then deeper ones.... the room become more quiet and the fun began. The first two disks were penetrated with no problem. Then while feeling more confident, the third needle struck a nerve and all I could do was say, in a moaning -too afraid to move or startle anyone way, Ahhhhhhaaaaaahhhaahhhhhhh. It was the largest "nerve" pain I have ever felt and a new"10" on my personal pain scale to date. The Doctor immediately pulled back and explained that he'll try another route. "The bottom space is always the closest." The other route didn't really hurt, but I could feel a sickening feeling of the needle rubbing close.
Finally, we got to the truly fun part. Well, at least productive part. :-) (This was all blind, but I fill in a few details from what I learned after the fact) They started talking about numbers, and then started asking me questions. "Do you feel anything different?, pause.... How about now?.....pause....Does this hurt?... do you feel pressure?..... and so on" Then once they figured thing out with my response, they started a new plan that I call "Make him say uncle!" (how much can he take). They were perfectly kind, but the pain wasn't. The bottom two disks were very painful when they added pressure, and then more-so when they added more. The top "Control" disk only felt mild pressure, and it was given something like 4CCs of fluid.
One key question that truly helped me in my final decision for surgery was: "Does this pain feel like the every-day pain you have?" and I answered a huge "YES." This was crucial because it clearly defined the major source of my pain.
In recovery, I was told by the nurse that my Diskogram was the smoothest she's been apart of in nearly 20 years.... so they're getting better. However, I couldn't walk well for the rest of the day, and I was in extreme pain for the next few days. I believe this is because the disks were made angry, and the additional pressure in the area took time to dissipate. Also, the nerve that was poked seemed to need a little while to recover. Regardless, I took this as another confirmation that the Disks were the cause of pain. Otherwise, I would be fine.
Please visit the complete blog entry and PHOTOS here: http://mrdjw.spaces.live.com/blog/cns!33B43BC384EEBA!222.entry