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Hello Doctor,
I’m a 45 year old, very healthy male (use to be very active until this injury) that has 3 herniated lumbar discs, numbers 2-5. This was caused by being bent over moving a very heavy box 3 years ago.
When I first had the injury, I had radiating pain shooting down my hip and buttock area for 5 months. When that subsided, the pain has been centralized to the center of my spine ever since. I can get by, still work(only because I have a job that is not physical), but the pain has never left the center of my spine, and almost anything I do that is physical makes my back pain increase and sometimes gives me minor spasms in the center of my back. At times I have very slight tingling in my left quad muscle, but I have not loss any strength or do not have any atrophy to that leg. I have tried rest, medication, physical therapy and spine injections, only to have no relief from the central back pain. Now my doctor wants to do a discogram to find out which disc is causing the pain, then to do a fusion if only 1 disc is causing the pain. If it is 2 or more discs causing pain, he wants me to wait until later in life. He said not to do a multi-level fusion at my age.
My question is about the risk of a discogram. My doctor told me there are new studies showing that by sticking a needle in a disc can cause more rapid degeneration of that disc. And since he only wants to fuse one level, what about the other two discs that were tested and should I even have this test? Will they degenerate to the point surgery will be needed in a few short years?
My MRI results:
L2-3: Small right/far lateral disc herniation/protrusion containing and annular fissure does not cause foraminal stenosis but does contact the right L2 nerve root in the far lateral foramen. Mild bilateral facet arthrosis.
L3-4: Broad-based right posterolateral/foraminal disc herniation/protrusion containing an annular fissure contacts and mildly displaces the traversing right L4 nerve root within the thecal sac and combines with endplate spondylosis and mild narrowing to the mildly narrow the right foramen. On sagittal T2 image 12 the herniation appears to contact the traversing right L3 nerve root in the foramen. No canal or left formainal stenosis.
L4-5: Right foraminal disc herniation with annular fissure does not cause significant foraminal stenosis. No canal or left foraminal stenosis. Mild bilateral facet arthosis.
L5S1: normal disc contour, canal and foramina. Mild bilateral facet arthrosis. No canal or foraminal stenosis.
T7-8: 2.7 mm focal right paracentral disc protrusion with annular fissure slightly contours the right ventral cord without causing canal or foraminal stenosis.
Thanks for your time and appreciate your answer.
The risks of discogram are overblown in the media in my opinion. One writer (Eugene Carragee) found some correlation with discogram and future problems but I have not found that to be the case. Many of my colleagues also agree.
Make sure that the discogram is performed with a 22 gauge needle and nothing larger. This should be the standard of care but I cannot speak for every discographer.
In addition, it is not common for a discographer to test “normal” discs unless there is some question of pain interpretation (such as a workman’s compensation case). A disc that is already torn (as indicated by an MRI) cannot be harmed by a discogram. Since you have three torn discs, these can be tested without worry.
I would also hope that only one of your degenerative discs was the pain generator.
Dr. Corenman
PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.Thanks Dr. Corenman
Dr. Corenman, what if the discogram results are negative, or turns out that my pain is discordant pain. What would be the next step?
The discogram is not an “end all” test. It gives a piece of information that has to be used in the global diagnosis to determine what the pain generators are and how to treat them.
If the discs were non-painful, then most likely, the pain generators are some other spinal structures. However, discs can be so disruptive that pressure won’t build in them and the discogram will be negative even though the disc is painful.
This is like a tube from a bicycle tire. A small pinhole leak can be found by pumping up the tube and looking for the leak. If there is a large gash in the tube, any amount of pumping will not allow pressure to build up in the tube.
Discordant pain is another matter. This piece of information colors the interpretation of the discogram and needs to be considered on a case-by-case basis.
Dr. Corenman
PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books. -
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