Discography performed today
Well, I got the answers I needed, but they are not the answers I wanted. Maybe they were.. maybe not. I've been trying to get this discogram done for a couple of years now... but I'm always too busy or Bertagnoli's out of town towards the end of the trip, or I can't consider having a discogram done the day before I have to fly home. It's done now.
C5-6-7 both look severely collapsed w/big osteophytes. C3-4 clearly has a significant bulge, but it's unclear how it it's involved in my symptoms. Remember that this is not about discovering about bad discs as we already know that... it's about discovering if there is a very positive relationship between the discs that seem bad and my symptoms. The symptoms we are not sure about are the neuro symptoms on the side of my face. There is no dermatome from my bad discs and that area. Some doctors pooh-pooh the idea that a symptom pattern that doesn't match a dermatome could be in play. Others have seen too many unexplainable situations to simply write it off as impossible. (Note that before I told Baumbach about C3-4, he told me that my known bad C5-6-7 are mostly not involved in this symptoms... probably higher up.)
Bertagnoli did C3-4 first. As soon as he attempted to pressuize the disc, he noted that he was unable to generate significant pressure as the dye immediately extravasated into the canal area. "Just like on Tuesday" (Some of you will have read my post in another thread about the surgery a few days ago.) With higher volume injection, he generated 7/10 pain in my shoulder. More importantly, it also generated a warm tingly feeling over the entire left side of my face in the same pattern that I usually experience. The rest of the day, that has been more active than usual.
He then moved to C5-6. He was better able to generate pressure, but the disc is pretty severely broken down... there was no question about it needing ADR.... only if it is involved in my symptoms. He clearly generated 8/10 without too much pressure, but the pain was only similar to my pain. I could not really call in concordant.
I suggested that we already knew that C6-7 was completely compromised... No need to test it. Bertagnoli agreed. Upon further consideration, while I did not want another needle in my neck, I was not comfortable with the non-concordant response at C5-6, so I asked him to continue. 9/10 concordant pain at C6-7.
Bertagnoli had to leave, so we did not get to debrief the results. I don't expect any surprises, but I look forward to the lengthy discussion we'll have tomorrow. What I know for sure is that if I'm considering cervical ADR, I'm clearly a 3-level procedure. These three discs have looked like this for some time and will not get undegenerated with time. I'm glad to get confirmation that my neuro symptoms in the L side of my face are related to C3-4. My interscapular pain is likely related to C6-7. However, I am still very high functioning to consider 3-level ADR. I cannot consider surgery before the GPN conference in May, in Miami. So, now I know. I'll let this cook for the next few months and if things don't improve substantially, I'll probably have 3-level Cervical to go with my 2-level Lumbar ADR.
While cervical discography without any sedation was quite painful, I've been functioning pretty well since then. It's 9:30pm and the procedure ended about 3pm. I've been to the hospital to visit my client (she's doing quite well.) I had dinner in my room, but went out later for coffee and dessert with a friend and have been working for the last few hours back in my room. I'm still a little sore and a little nauseous, but I've only had some Tylenol and ibuprofen. (I don't even carry a vicoden any longer.... probably should.)
I hope that the blow by blow report helps someone to understand the process better.
All the best,
Mark
|