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  • StephenF
    Participant
    Post count: 5

    Doc,
    I had a conversation with you 2 years ago regarding my cervical disc issues. Over time this issue has been mitigated by avoiding certain neck positions .
    For the last 2 years I have been dealing with peripheral neuropathies bilaterally from the waist down.
    A small sampling of my last clinical notes from my latest PMR.

    RADIOLOGICAL REVIEW: I reviewed a CT scan of the cervical spine from 4/14/2021. This is notable for intervertebral disc replacements at C5-6 and C6-7. At C4-5 there is a disc
    osteophyte complex with facet arthrosis and uncovertebral spurring on the left resulting in severe neuroforaminal stenosis at this level. At C5-6 there is mild uncovertebral spurring
    and facet arthrosis causing mild to moderate bilateral foraminal stenosis. At C6-7 there is prominent uncovertebral spurring on the left resulting in severe neural foraminal stenosis.
    There is mild neural foraminal stenosis on the right due to uncovertebral spurring. At C7-T1 there is mild facet arthrosis but without central or foraminal stenosis.
    I reviewed and interpreted an MRI of the lumbar spine from 5/1/2020. There is mild disc bulges at L2-3, L3-4, and L4-5. Mild bilateral facet hypertrophy noted at L3-4, L4-5, and
    L5-S1. There is mild bilateral neuroforaminal stenosis at L5-S1 without nerve impingement. No central stenosis. I reviewed and interpreted images of the lumbar spine MRI from
    8/24/2021. This is notable for mild degenerative disc changes with minimal bulging at L3-4, L4-5. There is a tiny annular fissure at L2-3 centrally with no central or foraminal
    stenosis. There is mild facet arthropathy at L3-4, L4-5, and L5-S1. There is no central stenosis. There is mild left L3-4 foraminal stenosis and mild bilateral foraminal stenosis at
    L4-5. Fatty infiltration of lumbar erector spinae muscles noted consistent with deconditioning.
    IMPRESSION: Stephen is a pleasant 59-year-old gentleman with:
    1. Low back pain.
    2. Lumbar degenerative disc disease.
    3. Cervical spinal stenosis.
    4. Cervical radiculopathy.
    5. Cervical myofascial pain syndrome.

    The PMR tried multiple injections including a medial branch nerve block with no results. The only injection that I seemed to get relief from was a midline shot between 3&4- and that was after 10 days , and it only lasted 4 days.
    My question is -are discograms mostly used by surgeons when considering surgery? Without posting all of my radiology reports I can say that I had a posterior midline tear at L2-3 that was on my 2020 MRI. The latest MRI shows it as a tiny tear-so there has been some morphology with this disc. None of my PMR doctors seem to give that tear a thought. Even after I had an episode(strain) where I couldn’t raise my legs off my seat and I was in terrible pain. They kept shooting L4&5 and it wasn’t helping. At this point I want to have a discogram, but the PMR rather declare me myofascial based on fatty tissues in my MRI.
    I am tall and thin but in very good shape. I can do 30 push-ups at a time and I have been working on my core for months now(because everyone says core,core-though it wasn’t weak. In the beginning I had NO back pain, just the peripheral stuff in my feet, thighs, butt, hips and I could touch my toes. Now I have to avoid curling my back in any way because of the pain. The way I read it , there is a lot of innervation of nerves around the higher lumbar. Would a discogram show whether or not the annulus fibers healed correctly?
    Not diabetic. I’ve had a skin biopsy at the Cleveland Clinic that showed no nerve damage. The neurologist declared me idiopathic, and she could do nothing else for me. EMG is normal. MRI Neurogram showed nothing remarkable.
    Age 59, 6′!” 155lbs.

    Thanks for your time and happy holidays

    Donald Corenman, MD, DC
    Moderator
    Post count: 8193

    Disc problems (short of a disc herniation that compresses nerve roots) will not cause nerve pain. With a normal EMG and normal biopsy, this leads to a diagnosis of idiopathic neuropathy. This simply means that we have not discovered the cause as our testing is not precise enough. Discograms will only diagnose disc pain generators and will not be helpful in your case.

    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.
    StephenF
    Participant
    Post count: 5

    I thought I read this differently as far as the disc being a pain generator beyond a herniation. With regards to a tear leaking out the pulpous and burning nerves, and or the annulous fibers healing inward to cause instability of the disc,etc….
    Does a good EMG mean that the nerve path is good and void of a sciatic neuropathy? But that doesn’t mean that the nerve can’t be a path for radicular pain?
    I guess I wonder how you are so sure (with all due respect), based on the info I supplied, that the disc is not the pain generator?

    Thanks Doc

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