Does discography damage the discs?

[annapurna]

Hello everyone - great discussion! Over the past two months, I've had discograms at a couple of cervical levels and one lumbar level.

The cervical discograms were intended to figure out which disc (or discs) were responsible for progressive myleopathy. Since all my cervical discs were "tall" on MRI with no significant bulges or herniations, were didn't think that myleography was going to tell us much. The discography showed a HUGE posterior tear in c6/c7 which leaked dye right onto the myleon sheath and every nerve root in the near viscinity - plus concordant pain. Other levels were normal or close to normal. Since the myleopathy was due to irritation rather than outright compression of the myleon, discography was able to identify it very well.

My lumbar discogram was intended to check the disc annulus for tears and leaks prior to chondrocyte transplantation. The disc in question is dark on MRI, but still tall. In order to prolong it's life, I decided to try nucleus chondrocyte transplantation. This is a fairly successful technique that can prolong the life of the disc by adding the living cells that produce the proteoglycan molecules in the nucleus. You need to do discography before the transplantation, though, to make sure the disc doesn't have any huge leaks that would prevent it from containing the new cells in the nucleus where they do their job.

I definitely agree with Mark, though about being prepared for action. If you stick a needle into a disc and do discography, you'd better be prepared to take whatever action is indicated: replace, repair, or watch-and-wait.

[Maria]

I'm so glad to see you posting again and very interested in what you are going to proceed with in terms of preservation of the involved disc.

Would you feel comfortable sharing more information with regard to where you'll be having this done and more about the procedure, expected downtime, recovery time and so forth?

I'm sure there is more information here about this perhaps in a different part of the forum such as articles however I'm sort of out of the loop re spine surgeries as I've continued to be avoidant successfully I think tho perhaps not if one considers returning to work and a very active life. I am happy with pretty good pain control for now and being more active and some other things as well.

How are your activity levels currently?? As I recall you worked quite a bit and were very physically active tho this is from a few years back.

Again, glad to see you post and thank you for the information that you've already given here.

[annapurna]

Thanks for the interest Maria!

I'm still fighting both knee and spine problems, but am doing okay with pain control. Physical activity is limited to swimming, yoga, and stationary cycling, however, I continue to hope for improvement in the future.

Chondrocyte transplantation is a fairly old technique and has been used to repair large, chondral lesion in the knee for the past 15 years or so. Chondrocytes are the living cells that produce both collagen and proteoglycan in cartilage and other connective tissue. Cartilage is mostly "dead" tissue (matrix) with only a few chondrocytes per unit volume producing more tissue. Some of us (luck ) folks don't seem to have very many chondrocytes in our cartilage and discs, so, we experience premature degeneration .

Lucky for us, chondrocytes are very portable. You can harvest them from someplace you don't need them, expand them in a lab (at great expense), then re-implant them somewhere you do need them. Like I mentioned before, this technique has been in use for repairing knee chondral lesions for at least a decade. For spinal discs, you can use add chondrocytes to the nucleus of a dehydrated disc to rehydrate it. The transplanted chondrocytes produce proteoglycans, which hold lots of water, and keep the nucleus from shrinking.

Dr. Bertagnoli has been using the technique for quite some time to restore nucleus material lost during discectomy. When someone has a disc herniation, the herniated fragment is used for cell culturing. In my case, I needed an ADR at c6/c7. This means I had an entire cervical nucleus available for culturing. That nucleus is now sitting, frozen at Codon in Berlin waiting for us to tell them to start the culturing process. If my cells grow (80% chance or so), then Dr. Bertagnoli can simply inject them into my dehydrated L4/L5. If they do their job, then I might buy years of extra life on L4/L5 before I would need ADR.

In my opinion, these celll transplant techniques fall under the "can't lose" category. Other than cost, they have very little risk and enormous potential for delaying the degenerative process.

Fun, eh?

Best to all!
Laura

[dshobbies]

Just curious, what is the 'great expense'. Is this legal in the US? What are the costs Germany vs. US?

Thanks, Dale

[annapurna]

I know that chondrocyte transplatation for disc nucleus restoration is not FDA-approved per se. On the other hand, chondrocyte transplantation for repair of chondral defects in the knee and other joints has been FDA approved since the early 1990's, so, it's possible that use of the same technique for spinal disc could be considered "off-label".

As far as great expense goes, I was whining. Codon, the German cell culturing company that ProSpine uses, charges about 7000 euros to do the culturing. That's actually a good price for cell culturing compared to the going rate for bone marrow or adipose mesenchymal cell expansion and similar. It's a FABULOUS price compared to the $70,000 that Carticel charges to do the same thing here in the states for autologous chondrocyte transplantation. Of course, Carticel has the US monopoly, so...

Like most folks, I'm trying to balance investing in my body vs. my bank account in the face of potential job losses in my family, etc. We're all there, I guess.

Best to all,
Laura

[Maria]

Laura,
this does sound very interesting and I'm wondering what the inclusion or exclusion criteria would be re the involved level/disc and if you know where to find that information.

It may be nothing that my long time disrupted disc levels are candidates for however perhaps adjacent levels that seem to be *ok*.. or at least so I'd like to think..

[Crystal33]

Regarding discography, when i read Carragee's paper I couldn't help but think of the many symptom free 'healthy' persons who have voluntarily undertaken the procedure in the past to help advance medical research and understanding. That a percentage of these persons will develop accelerated disc degeneration possibly leading to incapacity and/or spine surgery due to the procedure is tragic. Possibly they would have grounds for legal action, if they could afford it..

Carragee won an Award from eminent persons for the paper so I don’t think it can be discounted. Also he has no conflict of interest whereas Dr Derby benefits financially from discography. As there could possibly now be an increased risk of persons taking legal action if they have reasonable grounds to believe their spinal condition is result of a procedure which was described as safe or where risks were not disclosed providers of the service will naturally become defensive. Interesting how other posters here have mentioned actual personal adverse experiences.

One might wonder why Carragee would investigate the modern practice using fine needles, which is often described as safe. My guess is that with his vast research experience he suspected what the outcome would be from the outset. Us sufferers are indebted to people like him.

I wonder why Dr Derby, as a major provider, did not see or suspect any adverse consequences as identified by Carragee. Use of finer bullet tip needles sounds like a good idea and one could also wonder why this has not been the practice for some time. As larger needles have been previously established as a risk then surely use of the finest possible bullet tip needles would be a logical choice as providing the safest possible procedure for patients.

One would need to read Carragee’s full paper to see to what extent age, genetics, and any existing degeneration influenced the association between discography and accelerated disc damage/degeneration, assuming he addressed these factors.

I ’m surprised they don’t also closely consider post procedure activity (I assume they don’t). If two gymnasts underwent the procedure and one kept training each day but the other rested for a few weeks and avoided bending, twisting, lifting, I suspect the former would be at much greater risk of causing tiny tears at periphery of needle hole.

Personally I would avoid discography, unless absolutely no choice. Carragee has identified new unacceptable risks that add to existing risks regarding a procedure of questionable value.

The Discography Controversy: Discussion - Discussion Continued

FR Discography