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Discogram/discography CONFUSION!

Good evening fellow spineys!

I saw my neurosurgeon this morning and as he was in his usual rush I didn't get many (none really) of my questions asked. I like him a lot, and more importantly, I trust him, but damn- he is BUSY.

Okay- here is the deal.
I have DDD all over, but it's really impacting my lower back. I've read all of the stuff, I know it's not really a "disease" and that it can be usually handled with conservative treatment.

I've been dealing with the lower back issues for about 10 years but lately it hasn't been going away. I literally can't sit in a regular chair, can't fold clothes, unload the dishwasher, or do anything that requires partial bending (I can bend all the way, it's the shallow bending that gives me grief) without severe pain. I've done all the *stuff* over the years- PT, chiro, exercises, ortho, etc., to no avail. Usually these episodes come and go but this one is in the five month mark with no signs of abating.

Anyway, neurosurgeon mentioned the possibility of surgery on my last visit, which after reading everything on the Internet, I think I would like to avoid. In preparation for today's appointment I had a new MRI done last week (we have a 1.5 year old one that shows DDD) which revealed worsening DDD. Today he told me that my particular insurance doesn't cover lumbar fusion for DDD, so he has referred me for a discogram.

1. If insurance won't cover the surgery anyway, why do the discogram?
2. If the discs are *gone* (as they basically are in my case), what happens next? Do they just naturally heal?
3. Is staying on pain and muscle relaxers until this resolves on itself a viable option? My doctor will keep me out of work for as long as I need and has no problem with refilling scripts as needed.

My doctor said a few words that led me to believe that the discogram would give some kind of proof to the insurance company that the surgery was necessary. Does this make since? Like I said, he was so busy, and talking so fast, I was really only left with this impression. I looked up my insurance today and it clearly states that lumbar fusion is not covered for DDD or disc herniation, which is all I have.

I just paid for the new MRI and I know the co-pay for the discogram will be steep. Won't it just confirm the DDD?

Any input? Suggestions? I am confused!

Thanks in advance :0)

3/11/13 successful ACDF
7/13 inconclusive discogram
Currently in PT for lumbar pain


  • 64pvolvo1800664pvolvo1800 Posts: 250
    edited 08/07/2013 - 3:56 AM
    Discogram is immensely painful but can certainly show the extent of damaged to the discs. It's possible to maybe show nerve damage which may change the flavor of the diagnosis maybe? I have DDD but the DG shwoed all 5 L level discs were blown out like spiders leaking everwhere. Ultimately, they did an ALIF L5-S1 only because my surgeon would not do multiple level fusions. He believed that it was not juice wirth the squeeze. As it turns out, they waited toolong and I have nerve damage so bad that my right leg/hip/foot etc are always on fire and shooting pains. I have a spinal cord stimulator trial in two weeks and its been two years since the ALIF.

    Either way, living on pain killers and muscle relaxers will no nothing to heal anything and they bring on a whole new set of problems. Standing still and hoping it gets better without action is just a dead end street, speaking for me only, and I have to exhaust all options before I accept my plight of living in chronic pain. (There are many many days that living is no longer an option and I can go to a very dark place in my mind when hope is lost.
    IF the SCS trial fails, I may have to take early retirement and off myself. The chronic pain is no way to live.

    I wish you well pushing forward. Dont give up hope.
  • Born2RunBBorn2Run Posts: 32
    edited 08/07/2013 - 6:03 AM
    Thanks for your input and what you say makes sense.

    So, if the dye in the discogram process leaks out it might show a condition that is not merely defined by DDD? That answers the question of why he ordered the discogram.

    I know it will be painful- I've read all the stories :0( And to add even more pain, the place I will be having it done gives so sedation or pain relief. Oh well. I guess it will be worth it to get a definitive answer to this.

    I am so sorry for your pain. I know that dark place of the mind- I have been there a couple of times myself and, well, we just have to carry on. I hope you get some relief. Remember that advances and changes are being made every day. The great thing about the future is we don't know what POSITIVE things can come from it.

    I've read good things about the spine stimulator, so hopefully this will bring you some relief.

    I'm still trying to get a handle around the big picture. This is what I have been able to determine. Please correct me if I am wrong:

    1. DDD causes discs to deteriorate and bulge and possibly leak.
    2. The discs that are bulging from their allotted space between the vertebrae might be pressing on nerves which causes pain in that particular area.
    3. If the disc presses long enough on a nerve, there is a risk for permanent damage.
    3. Eventually, the discs will just whither away which will prevent them from pressing on nerves; thus pain will be alleviated
    4. Finally, there is no time frame for the discs to totally disintegrate. So, it is hard to tell how long the pain will continue.

    Is this all basically right?

    I applaud your effort to fight and not accept your condition passively! You are exactly the type of person who ironically, even though you feel weak, gives me strength to persevere and investigate all options.

    Thanks for sharing and best of luck!
    3/11/13 successful ACDF
    7/13 inconclusive discogram
    Currently in PT for lumbar pain
  • i had the discogram, to me it was no where near as bad as the nerve conduction test. i have also been on pain meds for over 2 years now, my decision, but i do not feel i am ready for surgery, it affects everyone differently. i know tommorrow i could wake up totally different, and be ready for surgery. but for me i am doing well as of right now. there are plenty of people that get surgery, and are still taking meds.
  • I've been on a variety of pain and muscle relaxer medicine for about three years now. This basically manages my problems but, and it's a big but, every year I am able to do less and less. Just today I got some water plants out of my koi pond and experienced instant horrible pain that sent me to the recliner with an ice pack for the remainder of the day.

    Is this going to be my life now?

    My pain is limited to my lower back and buttocks. I have had a few instances of sciatica, when I had searing pain in my butt going down the back of my thigh, but this has not happened for a while.

    Does surgery EVER work for this type of pain? The few success stories I have read seem to come from folks who had bad leg and foot pain.

    3/11/13 successful ACDF
    7/13 inconclusive discogram
    Currently in PT for lumbar pain
  • What did your discogram find that mri did not?

    I've heard that nerve testing is awful. I'm not worried about the discogram. I figure I can take anything for a few minutes ; 0)
    3/11/13 successful ACDF
    7/13 inconclusive discogram
    Currently in PT for lumbar pain
  • Born2Run said:
    What did your discogram find that mri did not?

    I've heard that nerve testing is awful. I'm not worried about the discogram. I figure I can take anything for a few minutes ; 0)
    The DG reproduced the exact pain i feel and the source of the shooting pains and identified which of the levels were really the culprit and point of attack for a "fix".
    Mine showed the worst pain was L5/S1 and when the dr went in to put the cage, he found the bone had been grinding away against the next level for so long that it was the worst he had seen. The cage separate the levels and took the pressure off the L5 nerve but it was too late. Almost two years later, the nerve pain persists even though my back pain was lessened by the ALIF.

    The NCS was a walk in the park for me. I've had a few on my arm and leg/back and they were just brief pinches as opposed tot he excruciating passing out or puking kind of pain created by the DG. Sorry to be so blunt but know what youre getting into. They cant give you relief because you need to be able to tell them about your pain as they pressurize each level during the DG procedure.

    Good luck whichever way you go. Get help before the nerve is too far gone.
  • BorntoRun, I had a one-level fusion in June. I had DDD in just one disk (L4-L5) and it was to the point that I basically had no disk left. My vertebrae above and below showed a great deal of arthritic changes and my spine actually hurt to touch due to the inflammation in the bone. Additionally, though I thought I had little nerve pain (no numbness etc.), I did have hip pain often and occasionally sciatica. When my doctor went in, he widened the channel that the L5 nerve root runs as well as removed the Lamina to grind up and use for the fusion. The fusion, when set, will disallow movement in the damaged disk and stop the pain. Now, I know what you mean about it gradually getting better on it's own. From what I've been told, by an orthopedic surgeon that I consulted with, my pain from DDD was due to the bone inflammation which might actually get worse as the disk continues to degenerate. Additionally, over time, the 2 vertebrae might naturally fuse, but that could take many years and doesn't typically happen till someone is older than 60. As I am 37, that didn't seem viable to me. Like you, I've had pain for 8+ years that came and went...occasionally my back would go "out". However, in the past year it got to a point that it was daily and even when I just would get up from sitting, I would be all bent over from the pain. Since the surgery...not quite 2 months ago, my daily pain is gone. I still have some surgical pain (mostly muscle healing), but it was very successful. The hardware alone keeps my bad disk from moving and freeing up that nerve root really helped, even though I didn't know I needed it! I had a less invasive technique as well, so I have 2, 2 inch scars and he didn't have to cut any muscle. I think that has really sped up my recovery. Good luck with everything! I never had to have the discogram, but my hubby did and he said it was the most painful thing he did. He's had his nerves burned multiple times without sedation and that doesn't compare in his experience.
    37-HS Science Teacher, Mother of 2 (8 and 11)
    L4/L5 Disc compression with spondylosis and severe arthritis in both discs
    PLIF on 6/11/13 (minimally invasive technique)
  • Born2RunBBorn2Run Posts: 32
    edited 08/08/2013 - 6:01 AM
    Thanks so much for sharing your experiences.

    It's great to hear a success story! Jill, it sounds like we have/had the same issues. Did you have a problem getting insurance to pay for your surgery? Was ddd your *official* diagnosis?

    I'm still confused as to how my doctor is going to convince insurance to pay for fusion with a discogram which will probably "only" show ddd??
    3/11/13 successful ACDF
    7/13 inconclusive discogram
    Currently in PT for lumbar pain
  • catfishmanccatfishman Posts: 185
    edited 08/08/2013 - 11:38 AM
    born 2 run, mine just confirmed l5,s1 was herniated.also some people on here had no pain when getting there nerve conduction test. they told me i would feel a shock like when you rub the carpet, yeah right, they must have cranked the voltage up on me, swear it felt like some kinda torture.
  • The discogram showed a ruptured, torn disc with a grade of 4. It basically showed what an MRI could not. Plus they put dye in and then do a CT scan after the discogram so you have that on CD and the dye just shows everything alot clearer. I ended up with L4/L5 fusion 10 weeks ago.

    Grade 4 tear in l4/l5 was missed in first MRI so did injections for a year
    SI joints "messed up" not sure if I will get them fused at a later time
    Had Open PLIF L4/L5 5/28/13
    Woke up to permanent nerve damage in legs and feet.
  • Born2RunBBorn2Run Posts: 32
    edited 08/15/2013 - 10:59 AM
    Well, I had it done at an imaging center today at 8:00 A.M.

    Two nurses prepped me with an IV of antibiotics and a light sedative. The sedative was so light that I felt no effects of it at all! I was put on a table stomach down and my back was washed with a warm antiseptic. The radiologist came in and explained the procedure and he started with the needles.

    It was a three level discography and I guess he had to get the needles in first before he could do the actual test. First, a very stinging needle was put in with a numbing agent and then another needle was inserted in the disc space. This part was absolute HELL, especially at the L4 L5 disc. Apparently, there was so little space he had a very difficult time getting the needle in correctly. He actually had to do it a couple of times before it was placed correctly.

    This was the most painful thing I have ever experienced. I can't even begin to describe the type of pain it was. I am not by nature a very verbally demonstrative person, but I moaned and almost ripped the vinyl cushion I was lying on several times. The nurse was holding my head and arms down while trying to soothe me. It was truly terrible and I could not have imagined a body was capable of experiencing this level of pain.

    So, after the needles were correctly placed at the three levels, the real test began with the dye injection. This only took a few minutes and it quickly determined the pain source. The doctor asked me what my pain level was. Since I had a brand new interpretation of what a level 10 is, I told him a 7, at the L4 L5 spot. The other two levels just felt like an uncomfortable pressure.

    At the conclusion of this part, a nurse gave me some pain medicine which immediately calmed down the a lot of the severe pain. I was put on a rolling bed and went straight to have a CT scan. By this time I had tears in my eyes and was trembling with the experience I had just endured.

    The CT scan took about three minutes and I was taken back to the nurse's station for a shot of diauldid and anti-nausea medicine. This immediately worked for the pain except for site soreness which they put ice on.

    I stayed with the nuses for 30 minutes and then was releases to my car driver. The whole thing took about two hours.

    Here are some observations:
    1. The radiologist refused to discuss any findings with me. I was very blunt asking him "Does it look bad? Good? Average? ANYTHING?" But he refused to comment and just said my NS will go over it with me.
    2. The nurses were super nice and were very sympathetic to my pain. They said that they hate doing these procedures because they are so painful. I asked them some general questions about surgery overall, and both of them were basically against it. One summed up their attitude garnered from 40 years combined RN experience: Back surgery begets additional back surgery. (**insert heavy sigh**)
    3. Uh, diauladid is AMAZING. What a drug. I literally went from sobbing, cringing, almost nauseating pain, to mere soreness in about one minute.
    4. And of course, the biggest surprise was, the herniated L5 S1 disc has not been the culprit as I thought. The L4 L5 is the source of all evil.

    Sorry for the long post- just wanted to give an honest description of the procedure.

    Any comments? How long will it take my NS to review the findings with me? What do you think he will suggest? Does the pain I experienced at that level indicate anything?

    As always, all input is appreciated!

    Also, my intent is NOT to discourage anyone from having the procedure. In fact, based on my understanding, this has maybe pinpointed my problem in a way other diagnostic tests could not.

    Thanks everyone!!
    3/11/13 successful ACDF
    7/13 inconclusive discogram
    Currently in PT for lumbar pain
  • 64pvolvo1800664pvolvo1800 Posts: 250
    edited 09/04/2013 - 2:49 AM
    But at the expense of PAIN!
    I've learned to appreciate the technician NOT commenting on the procedures. They can give you false worry and false hope. Patience is not one of my virtues but it is necessary in this business.
    I'm glad you found the culprit and as you learned, without the DG your dr may have planned a wrong level fusion. Maybe specific nerve blocks are next to try and calm your *edited to remove foul language* off nerves.
    Good luck. Surgery is a personal decision and I only went the because the quality of my life had gone so far down I had nothing to lose. It's a gamble and since you only have the one level problem, you may be a long time coming between the first and the next surgery. There will most likely be a next problem. Our spines move to make up for the geometric angle we confused with fusion. The problem will migrate to adjoining levels.
  • My surgeon also recommended a discogram before my surgery. He would not do the surgery withuot one. The discogram pinpoints where the problem is and slong with the MRI's and x-rays the surgeon knows exactly what needs to be done. I've heard people in the medical fields who say most surgeons rely on mri's and x-rays. I was glad to know that my surgeon wanted a discogram. His office gave me the name of a doctor that does this procedure.

    When I had my discogram, they put me in a twilight sleep while the doctor inserted the needles. I did not feel anything. After all the needles were in and they were ready to shoot in the dye, they woke me. You need to be awake so you can tell them where and how bad the pain is. I had several areas where the dye was injected and there was just a slight twinge of pain and that was until he he injected the last one....It was painful, but not as bad as I've heard some describe. Besides, it only last for a few seconds. Mine was L5 - S1. Once this procedure was done and my surgeon got the results and a copy of the CT that is done after the discogram we scheduled a surgery date.

    I had surgery June 2013 and I had both Anterior and Posterior done. I started Physical Therapy within 2 or 3 days after surgery and it continued both in the hospital and then in the rehab hospital and I also had P/T at home. I was discharged about 2 weeks ago from P/T and today from the home health nurse.

    I fully recommend physical therapy because without it I don't believe I would be doing as good as I am now. I'm not a youngster either, I am 72 and quite active, even now. I still use a back brace but I'm weaning off it. I also use a bone stimulator. The determination to get better is a big part of coming along at a quicker rate.

    Good Luck
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