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Discogram results showed pain in good disc?.

Hi everyone, I'm Tim, I've been dealing with back pain for 10 years after fracturing my L5 vertebrae. Over the years the pain and discomfort has gotten worse. I've done therapy, all kinds of injections with no relief. Recent MRI shows herniated disc at L4, L5 and pushing on the nerve. I have pain radiating to left side and tingling down left leg and into my foot. Saw an ortho back surgeon, and he ordered. A discogram so he could determine for sure what to fuse.

Had the discogram done 3 days ago. I had pain at L4 and L5, which was expected. But on the "normal" disc, the "control" disc which I believe was L3, they said I had a lot of pain also.

So speaking with the surgeon yesterday, he said according to the MRI, there should not have been any pain. But if he goes by the discogram, I need a 3 level fusion at L3, L4, L5. I'm a firefighter, 43 yrs. old. He said he wouldn't do a 3 level because I wouldn't be able to work as a firefighter any more. If he goes by the MRI, he should do a 2 level fusion at L4, L5. But with the discogram causing pain at L3, he said no guarantee the 2 level would help.

So, he said its up to me if I want to do the 2 level and hope it helps.

Is it possible the discogram wasn't 100% accurate? The Dr. said its possible it caused pain at L3 because of referred pain from the disc above. He said he'd hate to do surgery and it not help if L3 is causing a lot of the pain too.

I'm at the point I need something done, it's been going for too long, getting worse, I'm finding it harder to do my day to day things because of the pain. What do you guys think of all this? I'd appreciate any advice and anyone who's had experience with a discogram.



  • Discograms are notorious, not only for the terrible pain that they are renowned for, but also for the risk of false positives and negatives, etc, etc. My doctor told me that going in. But one thing she did mention is that just because a disc LOOKS healthy on the MRI, that doesn't mean it IS healthy. It may have annular tears or other issues with it, thus making the 'healthy' disc produce pain.

    My discogram was also somewhat inconclusive, but from what I'm told, that seems to be fairly common. I'd sit down with your surgeon and discuss your situation at length. Don't read too much into what the discogram showed or didn't show. It's not the last word.
    2015: Thoracic protrusions C7-T1, T3-4, T6-8
    Dec'13: 360FusionL4-S1 w/bone graft
    2013: 3x2-level disc injections: 12mo surgery postponement
    Dec'12: DiscogramL4-S1
    Sep/Oct'12: Bi-lateral Rhizo AblationsL4- S1
  • If your neuro truly feels like your L3-4 is healthy, then I'd go with that and just do the two-level fusion. Worst case, you can always go back and fuse that level too. But if your imaging shows that is appears healthy and you still have good disc height at that level, I'd say go with his suggestion. Especially since you said a 3 level would make you unfit for work. But that's just my opinion. I had L4-L5 and L5-S1 fused almost three months ago and my L3 still looks great.
    2015: Thoracic protrusions C7-T1, T3-4, T6-8
    Dec'13: 360FusionL4-S1 w/bone graft
    2013: 3x2-level disc injections: 12mo surgery postponement
    Dec'12: DiscogramL4-S1
    Sep/Oct'12: Bi-lateral Rhizo AblationsL4- S1
  • My discogram reproduced my pain at L4/5 and L5/1 and the tears were seen on xray and confirmed by the follow up CT, but I also had mild pain at L3/4, which is a healthy disc. Discograms are inconclusive sometimes, but if you had a good doctor perform the test, his or her interpretation and whether any abnormality was seen on the live xray and CT should be taken into consideration when discussing which levels to fuse.
    10/28/13 - ALIF, PSF, decompression at L4/L5 and L5/S1
  • Thank you guys for your responses. The CT following the discogram showed a perfectly healthy disc on the "normal" one, and tears and leakage on the two bad ones. I've been doing some reading and seeing that discograms aren't 100% accurate. Many stories of people having pain on a healthy disc.

    I plan on talking to the Dr. who did the discogram and the surgeon again before I make a final decision.

    Thanks again for the info guys. I'll post back here with updates and if you guys or anyone else has anything to add I'd love to hear it.
  • Sending good thoughts your way. Whatever you choose to do.
    2015: Thoracic protrusions C7-T1, T3-4, T6-8
    Dec'13: 360FusionL4-S1 w/bone graft
    2013: 3x2-level disc injections: 12mo surgery postponement
    Dec'12: DiscogramL4-S1
    Sep/Oct'12: Bi-lateral Rhizo AblationsL4- S1
  • a dye is injected into the disc in question and images are taken of the results. the dye is injected and if the disc is herniated, the dye will diffuse out of the disc space and show up on the images taken. it is usually given with other tests like mri to determine if a disc is herniated and where it is and at what level, it is one in a many types of tests used to see what is going on. i had it, mri, cat scan, nerve conduction test, injection of radioactive material to see if it was arthritic and injections to see where the pain came from plus also the x-ray. i also had a lasar disectomey to try to help but it did not. doctors use all in the tool chest to see what is going on. no test is perfect that is why a doctor will order a series of test to narrow down the problem
    I have 4 fusions from L5-3, the latest last May '12 where they fixed my disc that broke.They went through my side this time. I take 40 mg of oxycontin 4x a day and 4 fenatyl lollipops 300 micro gms 4x a day.
  • SarahLindeau said:
    Sending good thoughts your way. Whatever you choose to do.
    Thank you Sarah! I Have a consultation with the Dr. who did the discogram on the 31st, right after we get back from spring break. Calling the surgeon tomorrow to schedule a consultation with him also. Probably going to see one more doctor for another opinion, it can't hurt.
  • Just an update: saw a new Dr. Ordered a new MRI, and a bone scan. He didn't say a lot, he really wants to wait until he has the results of the MRI and bonescan. I'm scheduled to see him on Monday the 14th. He did say he thinks I may have scheuermanns disease, based on the angle of several of my vertebrae and that my pain may have a lot to do with the joints. He said there is a lot of narrowing in the joint space. So, I'm interested to see what his opinion is and what he thinks we can do.

    I'll post back with the details of the visit next week.
  • TeerumpTTeerump Posts: 9
    edited 04/14/2014 - 3:16 PM
    Saw the Dr. today. Wants me to get an anesthetic injection with long acting agent into the really bad disc and see if I get any relief from it, and see an endocrinologist about my bone density. He said it was lower than it should be for my age. Asked him if I get no relief from the injection, what was the next step. He said then I can't help you. Was really taken aback by that comment. I do appreciate his honesty but seems like he's losing interest in my issues. He did say he felt the discogram was done incorrectly. I should have been awake for it, and it's not always definitive. I don't remember anything about the discogram, I didn't feel anything.
    I'll post back after the injection.
  • PaulPPaul Posts: 730
    edited 04/14/2014 - 9:14 PM
    I had a couple discograms; I was brought in and out of consciousness for feedback. I have recollection of it as well.

    I'm praying you'll get relief from that injection. They do work. It worked on me. Hang in there and best wishes. Thanx for sharing your story and updating.
    On the sunny and mild Central Coast of California

    L4-L5 endoscopic transforaminal microdiscectomy June, 2007
    L5-S1 endoscopic transforaminal microdiscectomy May, 2008
  • TeerumpTTeerump Posts: 9
    edited 04/17/2014 - 4:23 PM
    Going in next Wed. for the injection. Did you end up having surgery? Or just getting periodic injections?
  • Wen in Wed. for the lidocaine injection into the L4, L5 disc. Was some confusion at first as to what the exact procedure that was being done. The Dr. performing the procedure said they were doing a discogram and going to pressurize the disc, then inject the Lidocaine along with a long acing agent. I was never told by the Dr. ordering the test that they were going to pressurize the disc. Finally, after the two Dr.'s talked on the phone, they decided to just inject the Lidocaine and see if I get some relief in the next few days.

    So far, I can say that my "normal" back pain is gone, but I am still sore from the injection on my right side. I was sore like this also from the first Discogram I had done. So I'm still holding off judgement right now, but it appears the L4 L5 disc is the cause of my pain, which is what we were trying to determine. I see the Dr. next week to determine the next step, which he has indicated is sugery.
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