Discogram...how common and how good are they?
 

I saw my local neurologist today in the hopes that he would support my trip to Dr. Bitan in NYC.

I asked him to arrange the discogram with CT scan to help diagnose the lumbar area, as well as facet blocks if necessary, that Dr. Bitan had requested in his resulting letter after our meeting.

I was surprised when the doctor said that he didn't think that our doctors did discograms anymore, since we have such good images from the MRIs. He said he would check with Radiology, but didn't think I could get one.

I have heard many of you talk about these tests. Are they really outdated or is my doctor out to lunch?

If they are good diagnostic tools, then do I need both of them? And just how much does the discogram hurt?:o

The facet blocks are done to see if they help your pain. If they do, then they know you have facet pain. Which is/can be caused by facet arthritis, which is an exclusion to ADR. An MRI does show arthritis; but the degree of it is debatable, depending on who is reading it. My radiology reading of my MRI said I had moderate to severe facet arthritis. All 3 of my surgeons believed it to be mild to moderate. They also believed this because I had had facet blocks and they did not help. Which led them to believe my pain was coming from my disc.

On to discograms, I have had 2. The first one was pretty painful and I was given very little medication, as they want you to be alert to tell them if it hurts or not. The second one was wonderful. I was sedated while all the needles were inserted, woken up, asked the does it hurt questions and then sedated again. This really depends on who does your discogram, if they will give you sedation or not.
What happens during the discogram? They inject some 'control' discs (ie. good discs, not believed to be causing pain). They ask you what you feel, generally on a good disc you will feel pressure; but no pain. They then inject 'bad' discs (the disc or discs believed to be causing pain). They ask what you feel, usually if the disc is the pain source, this will re-create your usual pain. They don't tell you which disc they are injecting and don't do it in any order, to make sure you don't know. The theory is that the bad discs will cause pain and the good discs won't. They can also see the dye, is the disc holding it? Is it leaking out rapidly? How much dye did they have to inject? And more that I don't know.

I have heard it said that they are not foolproof and not that good of a diagnostic. It worked for me, both showed my L4/5 as painful and re-created my pain exactly. Some people have a myleogram instead or in addition to a discogram. I don't know what a myleogram does, so maybe someone else can explain that.

This test seems to be still commonly used but also a little controversial. My surgeon told me I did not need one as the MRI was obvious but there are times when it might help to positively indentify or confirm a bad (pain generating) disk that may not be so obvious on the imaging and thus possibly prevent a incorrect surgery at the wrong level or on a disk that is not a pain generator even though it looks "bad" on an MRI. A negative discogram might hint at possibly other reasons for the back pain.

Another tool in the diagnostics tool chest.

For example a european surgeon requested I do a bone density scan, also a test that here in US I was told there was no reason for me as a younger male to have one unless I had fractures or... Insurance would not pay. I requested that test anyway and it showed weak bones (T -2), a very good thing to know ahead of a spinal surgery.

A myleogram comes with risks of strong headaches and possible infection due to the injection of the dye into the spinal canal. A remote but real risk that need to be weighted against the benefits. The best diagnostic test is one with no risks, on that is safe to do. So it seems accepted these days that one only does a myleogram when there is clearly something going on that can not be explained by an MRI or in a case like Justin (see his thread) where it is used to get a good image where MRI can't, like after an ADR surgery. MRI doesn't work with metal objects like ADRs.

fuzzy, is a myleogram the same as the discogram? So my doctor here may be correct? One problem Dr. Bitan had was that the newest MRI was 'fuzzy' in the cervical area. He was able to compare to the 2007 images, and that lumbar area was fairly good to view (not that the discs were good). He was asking for the discogram etc. to make a final diagnosis to give to the insurance, in case he was missing something with the MRI, I presume.

discogram
 

When I was seeing a Neurosurgeon here in the LA area (2 in fact ~ One for each surgery) they wanted myelograms done before surgery.

I don't want another one of those because of the horrible spinal headaches I've gotten each time afterwards that necessitated being hospitalized for 7 days each time, lying flat all the time and being catheterized (the least of my concerns with that leaking spinal fluid).

Ok so then I decided in 1998 I would see an Orthopedic spine specialist and a discogram was recommended. I remember not wanting to have it done because I didn't realize it wasn't like the myelogram. No googling back then at least not for me..

Well I did it anyway and the first one was the most painful in terms of post procedure pain. Lasted 3 days. But after that I felt better for a month like the discs had been rejuventated with fluid.

Ok, that being said in '03 I had another one done by a different doctor in San Francisco and this time I asked for something to be injected afterwards to help alleviate the pain as I was supposed to fly home the following day.. he put Marcaine into the sites tested to help with short term relief. It did help.

The 3rd time I had a discogram done I had it done by another different person, my PM in San Diego and I asked for a lumbar ESI afterwards which was done and this is the discogram for which I had the most relief afterwards.

The problematic discs could elicit (should elicit) a painful response from you which lets the doctor know which discs are painful to you considering the pathology present at each tested segment.

For me the pain was short lived even if I yelled during the most painful disc which was L5S1.. however I didn't want to have really bad discomfort when I was trying to put on my underwear and clothes like I did the first time when I had to ask my husband help me with that after the procedure.

Here in CA. the discogram seems to be utilized pretty widely with Orthopedic Surgeons ordering it altho I think most Neuros would order a myelogram esp. as protocol prior to moving on to surgery (no matter what the MRI says).

I think the discogram with the CT scan following can be quite helpful and pick things the MRI doesn't show. Again it may depend on what specialty is ordering what and in what state you live in as to who orders what when for what (standard of practice in the community).

Mark can tell you much more as can probably Justin and Terry and others here.

Katie,

I saw 4 different doctors concerning my ADRs and each wanted a discogram. It is a relevent diagnositc tool when done skillfully. It is less accurate when done under anesthesia but far less painful. My MRI showed 4 bad discs but the discogram showed L2/3 was not a pain generator. Perhaps with severe injury, and MRI is enough but iffy discs need additional verification.

For the most part, the intense pain is so short lived, about 1 second, that fearing it is a waste of time. By the time you react to the pain, it's over.

All the heavy hitters require this test. Your doctor is out of date. Tell him all the best ADR doctor in the world insist on it.

Good luck, Dale

From what I have read and heard, I agree with Dale.

Also, to second Maria, the CAT scan immediately after the discogram did get better images than my MRI and showed the severity of the tear in my disc.

I, personally, would not have ADR without doing a discogram. Just what I would do, as we are all different, others may not see it that way.

Thanks all. Did I miss something though? The difference between a myleogram and a discogram?

So I do want a discogram with some pain killers or anesthetic, I guess.

Dr. Bitan is so far above any doctor we have here, as far as I'm concerned. I don't understand why anyone would question his requests. It is just such a dance to get what I need and want and still be able to talk to the local doctors afterwards. But they mostly have such fragile egos.............

The doctor I spoke to today put it best...how many Neurosurgeons does it take to change a light bulb? Just one...standing still, while the world revolves around him. This doctor is trying to warn me about the consequences of trying to get treated with local specialists, if ever there was a need, if I go elsewhere for treatment, and I respect that, but think the need to warn me is ridiculous. How dare they anyway....

Having just gone through an MRI last month, a discogram this month, then Epidural injections (again) last week, i can tell yu they certainly do do them!
At least here in Colorado.


The Discogram was what found my 4 disc's gone.

Good luck!

Ali

Everything you wanted to know about a myelogram.

Everything you wanted to know about a discogram.