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Could a disc be positive but not show on a discogram test?

Apokiliptik1AApokiliptik1 Posts: 3
edited 06/11/2012 - 8:42 AM in Back Surgery and Neck Surgery
Hi i am 9 weeks out from L3-L4 PLIF and i am having the same symptoms as before the surgery(sharp pain in low back burning and tingling, numbness in upper butox and down the back of my left leg).Well, my PMDR did a discogram at L2-S1 levels and the only one to cause pain was L3-L4 so i had a surg consult and decided it was best to do the PLIF (thinking that was the problem)at that level , well when i was injured in 2007 they had an mri with contrast and found the the disk at that level was abutting the nerve with a 4mm protrusion narrowing the spinal canal also the mri showed i had a 2-3 mm tear in my L5-S1 disk and a 4mm protrusion in that one also. I had a lamenectomy done on my L5-S1 disk in 2006 and my PMDR was kinda surprised that the discogram didnt show that L5-S1 was painful now being that i had the surgery on L3-L4 I am in the same boat as before and same pain as before sugery since my injury and the surgeon wasnt concerned with that level(L5-S1) but didnt spend alot of time looking over my back in post op last week was just concerned with his work and thought that there was a screw too close to a nerve but wasnt per ct scan i had 2 weeks ago but the ct showed the same problems with my back as the mri from 2007. Now my PMDR thinks its the L5-S1 disk because of the symptoms and the tear and protrusion.So is it possible that the L5-S1 disk has been the problem the whole time but didnt show up on the discogram i had done?


  • I have had a discogram done twice and have gotten the same results from both. But I dont think any test is 100%. It is possible that it didnt get done properly or something I guess. I am no Dr. What did your Dr say, and what is he planning on doing?
    I am trying to put this nicely as not to offend you, but, in reading your post it was one long sentence. It was hard to follow, so please use punctuation, so that we can follow your thoughts. I hope I have answered your question. I don't think any test is 100%. Errors are made every day.
  • Sorry I am not an english major. As far as being offended,nope doesn't bother me at all.I pretty much understand that any test isnt 100% proven.I was just asking if anyone here has heard of a discogram giving altered or inconclusive results? My Dr. is planning on doing a nerve block but I do not have my hopes up because i have had them before with no results.I do remember my PMDR saying the L5-S1 disk is the hardest to inject for a discogram, maybe the fluid wasnt injected properly I don't know.I do know I'm in pain and it takes away from my quality of life(as all of you know).Thanks for your reply
  • I am surprised that the surgeon was not more concerned with L5-S1 if your symptoms are as you describe. From the location of your pain, it sounds like a typical S1 nerve pattern. (You can take a look at a dermatome map or chart to verify for yourself.) L3-4 pain is more frequently located on the front of the thigh and wrapping around toward the inner thigh, sometimes running down to the foot, but not behind the knee or leg.

    Did you have any diagnostic nerve blocks in addition to the discograms? Discograms are not 100% accurate. The results depend on the patient responding "accurately." There are many studies that are available to laymen on the internet that show the many ways that discography can be inaccurate. It is probably the most unpredictable and controversial of any of the tests.

    Unlike MRI or X-ray, which is what it is, the discogram has a number of areas where there can be false-positives. For example, the doctor performing the test can provoke pain that would not normally be present if he accidentally locates the needle and injects into the annulus fibrosus rather than the nucleus pulposus of the disc. This could create a false reading. Or the patient could respond in a way that does not accurately predict damage to the disc.

    But the CT scan given after the injection of the disc should help to pick up most false positives...but it does not always happen.

    Most of us on the board are not medical doctors and cannot really answer your questions...but it would seem that you PM doctor may be onto something. It may be that you had two pain generators, and one was repaired, leaving you with a lingering problem at L5-S1.

    Looks like you'll have to continue trying to chase down the cause of your ongoing pain.

    Good luck.

  • I can't vouch for your discogram dr. but I do know that my NS was only going to fix L4/L5 - the disc that looked the worst until the discogram showed that it was L5/S1 that was the pain generator.

    I very likely could be in your position - having had surgery but still having pain just because they fixed the wrong disc. I'm sure it happens, discogram to the contrary or not.
  • and they showed 3 tears in the discs, that no other test would show. I had a two level fusion based on the discogram showing the bottom two discs were severe, and the other, not as much. I still after 15 months, have severe pain, and am thinking the discogram, was not totally accurate. That maybe the third disc is worse than it appeared. Or that possibly it has become worse after the fusion.
    I have had nerve blocks that have not be conclusive before I had the discogram. So, I guess my answer is yes, and I apparently have the same problem as you, only in a different level.
    By the way, I am not an english major either, and misspell all the time. I really, truly was trying to help, not offend. Take Care, Robin :)
  • Thanks for the responses. Still not offended robin! Yea i completely feel the way Gwennie responded. I told my wife from the get go that the pain i feel is the same pain that I had and was fixed via laminectomy on my L5-S1 disk a few years back. Needless to say I think they did the wrong disk. A couple things seem at odds with me. I had no post ct done after the discogram. Also on my surgical consult the Dr, he didnt examine me just asked me whats going on, I told him, and also showed him where the pain was. With that, why wouldn't he look at L5-S1? cause I'm pretty sure he should know where the pain is being generated from. He told me since the discogram was positive for L3-L4 that was the problem, wouldn't he know that my symptoms were more evident to it being my L5-S1? Now, i have to go through all this over again and if they decide to do anything about L5-S1 I am going to run into another problem.I have my L3-L4 PLIF and if they "DO" anything about L5-S1, my L4-L5 also has a 4mm bulge so , is there going to be even more pressure put on that disk? I was told I was going to have a domino effect(cause of my ddd and the plif), but wasn't quite certain it would be this quick or that I would have the same pain after the PLIF. Thanks again for the info and replies!
  • that your Dr is doing the right thing, maybe you should have another opinion after you find out what he proposes. I dont know why they didnt do a CT, it is standard procedure after a discogram to confirm where the dye goes after the discogram.
    If your L-5 is in fact the culprit, and they do a fusion, I would think they would consider the L-4 if it has a bulge already. But I am no Dr. Just make sure that you are satisfied what your Dr is doing, or seek out another opinion or how ever many it takes to convince you that they are doing the right thing. Already having one disc fused, if I were you I wouldnt want to chane the middle one going and making it three seperate fusions. Good Luck. Gwennie is a great friend and has so much info. Take Care, Robin
  • a discogram is not always accurate. Gwennie and I are discussing this also about false-negative results. My discogram was negative, despite all my pain at L5-S1, I didn't like the test and really was never asked if it hurt and what was going on so I didn't know when to speak up and afterwards i was in agony for 2 days, and I had no CT following my discogram either. I am having another decompression surgery at L5-S1 due to my symptoms and not having a fusion because my doctor told me I don't need one because the discogram was negative, I have DDD at this level. I just hope I am getting th right treatment based on the results of my discogram.

    In conclusion I would say that this test is obviously not always accurate and I wonder why doctors are basing such big surgeries based on these findings?

    I wish you luck in getting to the root of your problem because it sounds as though your right if you have a fusion at L5-S1, it will effect the level above it, maybe you need to get several opinions.

    Take care and good luck,
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