connellyMemberNovember 27, 2011 at 5:05 amPost count: 2
How important is it to have a ESI or TFESI injection to determine if the back pain is coming from a Degenerative disk? Can you rank tests and film in order of importance in determing Degenerative disk disease.
thank youDonald Corenman, MD, DCModeratorNovember 27, 2011 at 1:04 pmPost count: 8468
Tests are very important but in context.
For example, if a patient has spinal stenosis and significant back pain only with standing that would be relieved with bending forward or sitting, I would order an epidural steroid injection to temporarily “numb” the spinal canal. Pain relief may lead me to consider a decompression.
If there was buttocks and leg pain as the symptom, a selective nerve root block would help to diagnose which nerve was causing the pain.
Back pain with standing and loading of the spine might require a discogram to determine if the disc is causing pain.
Finally, if there is pain with extension (bending backwards) as well as standing, consideration of facet blocks needs to be in the discussion.
A patient with isolated disc resorption at L5-S1 with Modec changes, endplate fractures and absolutely normal discs above with the appropriate history and physical examination might not need any diagnostic testing for a surgical discussion.
Dr. CorenmanconnellyMemberNovember 28, 2011 at 4:02 amPost count: 2
Thank you for your response. One more thing.
I have a severe degenerative disk at L5 S1 along with severe right neural forminal stenosis. Trouble standing and lots of pain sitting.
If discogram is positive for this level -L5S1- does that positively indicate a fusion is needed and what percent success might be possible? (I read about your sucess rates on this page and was wondering if this situation might apply)
Really learned alot from you web site–thanksDonald Corenman, MD, DCModeratorNovember 28, 2011 at 7:36 amPost count: 8468
Severe degenerative disc disease with severe right foraminal stenosis can cause two types of pain- lower back pain from the disc and buttocks/leg pain from the stenosis. Normally, if the other discs are intact/normal and the pain is generated from the L5-S1 level only (the history and physical examination is appropriate and diagnostic testing confirms), then the success rate for surgery should be about 90% for 2/3 relief of pain.
Testing might include a selective nerve root block for the L5 nerve and a discogram for disc pain generation.
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