Discogram more painful than 3 lvl fusion?

[real_army_wife]

Hi there! I'm new here, so I'm sorry if I'm breaking any rules! I tried making sure I wouldn't, but it's hard to navigate from my iPhone.

Two days ago, I had a discogram to test my 3 bad discs (lumbar). If you do not want to be scared before yours, stop reading now. I am the type that likes to over hype myself, so I know what I'm getting into. Let's put it this way- I've given birth to 4 kids. I've had gallstones. I've had my large toenail surgically removed without the lidocaine working. I researched this procedure, as well as know off hand, as my husband has had one. I was so "hyped", my BP was 188/115. Let's just say that the discogram was the WORST pain Ive ever felt. I sobbed, screamed, almost fell off the table, and said the "F word" at least a dozen times, something unusual for me. It turns out that L 3-4 is a grade 5 (the worst) and L4-5 and L5-S1 are grade 4. Rated all at 10/10 pain, but the grade 5 was a 50 out of 10. The Dr said its likely that a 3 level fusion is what's required, but my "real appt" isnt until the 25th to speak to the surgeon team, who are rated 6th in the US. My question is, will the recovery from the fusion be as bad as the discogram? How would you compare the recovery? The night of, I was still in excrutiating pain that dilaudid was not helping. Here is a little more back ground for those of you that can hopefully help!

In 99, at 19, I injured by back. 3 discs were bulging per the MRI. In the last year, it has gotten in tolerable. An MRI last year said I had have 3 herniated/torn discs, spinal stenosis, facet athropy, and SI joint issues. After numerous PT, injections, etc, I decided to go through with the discogram. My husband was wounded and disabled in Iraq, and went this road. I remember how painful his discogram was. Then his 2 level fusion had complications, leaving him in a wheel chair for 2 years, ultimately having to retire from the army at 30. Of course that had me against the fusion for a while. Then came this, and I cannot function without major meds, and a cane everyday. I have 4 children, and am only 32. They say a 3 level on a 32 year old is a terrible thing. But my surgeon said all 3 were too bad to salvage. They've initially said that they would go through my stomach (even though as a woman, Id rather not have a scar there. Would that make recovery easier or harder than through the back? Anyhow, please be honest. Even if it's bad. I'm also in a rush to have this done before school starts the end of August. Pushing it, I know.**Thanks for reading. Have a great day!

[jsewell]

Real Army Wife,
I too had a discogram on multiple levels of my thoracic spine. I agree it was the worst pain ever. I was able to remain on the table but not without tears, wimpering, crying, and moaning. I had problems with a level in my thoracic spine which was no longer allowing me to stand very long or walk very long without needing to lay down . Even in the airport at the horror of my 4 kids. I too gave birth to 4 kids, have had a total hip replacement, lots of spine surgery with many complications, lung surgery etc. Still that was the worst pain EVER. I am not fused through different surgeries from C4 thru L4 and in 3 weeks will have surgery from T5 thru L5.
Nothing i have ever done or had done has compared to the sheer pain of that discography. So don't fear the surgery. It is painful to get out of bed after the surgery, the physical therapist will have you log roll and get up a certain way, but still think of the discography and you will know you can do anything. I always said nothing was as painful as childbirth until that.
At the time i rated T 6-7 a 20 out of 10. I underrated some of the other levels until it came to the other one which was really bad. I could not call the really bad levels a 10, had to be a 20!!.

I did have surgery to remove the disks at those levels. For a few months i still had the same pain and was thinking it was all for nothing, but believe me it all cleared up and i have not felt any of the pre surgery pain.
Don't worry and ask any questions you have
judy

[real_army_wife]

Thanks for your reply, Judy! I told the nurse that I now will have to rethink the 1-10 pain scale, since that was beyond excruciating. I know that I will NEVER have another one of those, no matter what!

Originally Posted by jsewell

Real Army Wife,
I too had a discogram on multiple levels of my thoracic spine. I agree it was the worst pain ever. I was able to remain on the table but not without tears, wimpering, crying, and moaning. I had problems with a level in my thoracic spine which was no longer allowing me to stand very long or walk very long without needing to lay down . Even in the airport at the horror of my 4 kids. I too gave birth to 4 kids, have had a total hip replacement, lots of spine surgery with many complications, lung surgery etc. Still that was the worst pain EVER. I am not fused through different surgeries from C4 thru L4 and in 3 weeks will have surgery from T5 thru L5.
Nothing i have ever done or had done has compared to the sheer pain of that discography. So don't fear the surgery. It is painful to get out of bed after the surgery, the physical therapist will have you log roll and get up a certain way, but still think of the discography and you will know you can do anything. I always said nothing was as painful as childbirth until that.
At the time i rated T 6-7 a 20 out of 10. I underrated some of the other levels until it came to the other one which was really bad. I could not call the really bad levels a 10, had to be a 20!!.

I did have surgery to remove the disks at those levels. For a few months i still had the same pain and was thinking it was all for nothing, but believe me it all cleared up and i have not felt any of the pre surgery pain.
Don't worry and ask any questions you have
judy

[Maria]

I've had 3 and they didn't hurt anymore than my back going out or flaring up terribly over the 20 years before I had the 1st discogram done! With the first one I learned that with the 2nd I asked for something to be given in the disc space to help with the pain afterwards so I was given Marcaine in the injected discs. The 3rd time I had an ESI (epidural steroid injection) done after the discogram so that was even less pain and longer duration of relief!

My discograms were 3 levels... re a 3 level fusion ~ were you checked out to see if at any levels you could have an artificial disc vs. fusion? At least you've had your children already so you won't be trying to get pregnant and go thru that having a baby/toddler to deal with after your recovery should you have a multi level fusion.

I was slated to have a 3 level global fusion in 2001 and decided against it waiting to see if I would be able to have artificial discs implanted instead and even tho I had multiple recommendations for at least 2 level ADR or hybrid surgery with ADR and fusion I didn't have any of it done as I felt better enough after many years of pain (like 20 plus) to not have more surgery (had 2 discectomies already w/2nd one failing terribly).

I think how you do post fusion is pretty individual and I would think the pain would be worst than the discogram in that it's prolonged while you recover and hopefully you will recover well however again I think that is very individual. I'd not try to rush recovery that's for sure as that could lead to more problems and more surgery sooner than later. Many people that have fusions seem to have to have more surgery/more fusions.

My last spine surgery was in '92. I hope to keep it that way tho I do have flare ups and I still have problems. I think tho I'd have more problems if I had had more surgery particularly fusion from what I see of persons having fusions.

However only you know how badly you're feeling and functioning. I don't use a cane tho I don't work any longer and I do take a low dose opioid pain med daily. I think it's a fair trade off however for how well I think I'm functioning most of the time spine wise.

Wishing you the best with whatever you do and please don't make your decision in haste.. really think it out and make it from a mental place that where you're thinking clearly and not feeling under the gun to make a decision if that's at all possible.

[real_army_wife]

Hi Maria,

I think a main issue was that both the sedative (versed) and pain killer (fentanyl) they injected did not work. They even tried 3 times. They also injected steroids, but that also was excruciating, so I screamed for him to stop. What were the findings of your discograms? Do you remember? Also, have you had surgery? Thanks for your reply!

Originally Posted by Maria

I've had 3 and they didn't hurt anymore than my back going out or flaring up terribly over the 20 years before I had the 1st discogram done! With the first one I learned that with the 2nd I asked for something to be given in the disc space to help with the pain afterwards so I was given Marcaine in the injected discs. The 3rd time I had an ESI (epidural steroid injection) done after the discogram so that was even less pain and longer duration of relief!

My discograms were 3 levels...

[real_army_wife]

Maria- disregard my questions!! Sorry! My phone only showed the 1st paragraph!

[real_army_wife]

Besides my bad discs, I have facet athropy (arthritis), DDD, spinal stenosis, and SI joint issues. From what my surgeon has said, a laminectomy is off of the table due to that. I will ask about artificial discs. Can you do that without a fusion? I've been deciding on surgery for over a year. Mainly because I needed it over the summer, due to my 3school age kids, and 4 year old. I'd have to stay with my mother who lives in a different town, because my husband works crazy hours. I know I don't want to wait another year. To function I take 2- 10/325 percocets a day; 1 zanaflex every 8, 1 mobic a day, 1 Valium at night. I also was on some cream, and lidocaine patches, but it caused eczema on my back. I just cannot function like this, but can't stand to live with the pain either. Thanks for your help!

[jsewell]

Real Army Wife,
I so agree with you regarding the pain of my very bad discs. However i had a 6 level discogram. as i mentioned i had 2 very very bad and painful like nothing my back ever caused levels. the other levels which all had tears and little problems hurt but not that bad compared to the super painful levels. I only gave them a 6 on the 1-10 pain scale. Probably would have scored higher if i had not had the excrutiating levels.
I also had a thoracic fusion first before the discogram which did nothing to stop my pain but was also very painful. Neither my doc nor i could figure out why it hurt me so bad . I lay in the hospital bed for days without moving in a crunched up ball until my surgeon came in several times a day and moved me up and straightened me out. A few months later it was discovered that i had an imflammatory muscle condition called polymyalgia rheumatica. So with my back muscles already inflammed (as were the rest of the muscles in my body) the cutting of the muscle sent me into horrible pain. Even though i softly cried constantly for days, it was not as bad as the pain from my discogram!!!
I have had some huge fusions, the first do to scoliosis and a quickly advancing kyphosis. It was affecting my lung function and i already had a 50% loss of lung function. I was almost on oxygen so I had to do the long fusion. But i don't really have any problems with it. I am much better off. I know most people on this site are for ADR's, as i said i was never a candidate. Another long fusion starting in the cervical area happened because i broke my neck. So that could not be avoided as well. So fused from C4 thru L4 has not been a problem . a little stiffness and only with the last level added did i have problems standing up straight. But it has been a year now since the last fusions and it is getting better , but it was not painful . Just a hard to explain uncomfortable feeling but it is also do to my curve being messed up and not having enough of a curve to my spine.

I think you will be fine, but do find out all you can about ADR and if you are a candidate maybe at your young age that is the thing for you to do. Do find out though
judy

[Maria]

Army Wife,
the biggest thing when wondering if you're a candidate for ADR is to make sure you see someone that does both ADR and fusion. A surgeon that mainly or only does fusions is going to tell you that you're not a candidate or put this type of surgery down.. even if you might be a candidate.

My findings were an anular tear at L3 which I've had forever, bulging disc at L4 (had surgery on it and it rebulged) and worse disc was L5S1 with bulging and so forth even tho I also had surgery on this disc (discectomy). Also DDD worse L3-L5S1, scar tissue on the rt.S1 nerve root and so forth, so on.

I've developed facet arthropathy too and have SI joint probs in the past and just about every rotten symptom possible in lumbar area then finally after many years living with really debilitating chronic pain my L5S1 area auto fused and that has given me an incredible amount of relief! Not that I don't still have pain because I do with L4 still but I cannot see having more surgery and taking the time out for recovery and not knowing whether I'll function any better than I do or whatever... and probably setting myself up for more surgery.

I'm 58 and if I can keep going like I am hopefully if I do have to have another surgery it will just be one more because of how long I'm waiting!

However you sound fairly young and active still with kids and such so you have to do what you have to do in order to try and regain your life~ that's understandable.

Before you go see anyone else just make sure to find out if they even do ADR if you might possibly be a candidate even at one level. I was offered a hybrid surgery with ADR at L4 and fusion at L5S1 but I don't like the idea of fusions and the screws. Mostly the screws. Plus I was just worried about being worse off and adjacent segment syndrome (fusion putting more pressure on discs above or below to perform) tho not sure if this doesn't happen with ADR too.

Good luck! It's a difficult position to be in re researching surgery and what to do tho hopefully you'll make the best "informed" decision.

[mmglobal]

Army wife... welcome to the forum and I'm sorry that you are having such problems.

I'm curious about why they would be doing discography on a grade 5 disc? Normally discography will be used confirm the source of pain generators or to rule the 'less bad' discs in or out. Typically, the grade 5 discs will be included in any surgical plan, so why test them?

I also wonder about the order of testing. In many cases, having a 10/10 response will so severely frazzle the patient that he/she will be unable to give reliable pain responses after that disc is tested. Many of the doctor's I've watched doing discography will test the expected 'good' discs first because they know they may not get a usable response after the 'bad' ones.

Regarding uttering the F word... When I was in Munich for my ADR surgery, Dr. Zeegers was highly motivated to rule the 2nd disc out, so I'd get a single level procedure instead of a 2-level. He kept on going back and forth trying to determine if the less bad response could be interpreted as negative. I was screaming so much that Dr. Zeegers stopped and said, “Mr. Mintzer, there are other patients waiting outside. They can hear you and you are scaring them. “

My reply, only half joking was, “Oh, fuck them.” That was my 3rd discography, but my first one with zero sedation. And my pain was certainly discogenic pain as evidenced by my amazing recovery following my ADR surgery. However painful it was, the discography was critical in deciding how we would proceed.

I’ve held people’s hand through discography more than 50 times now. I hope that your experience was like most that I’ve seen. However bad the momentary pain upon pressurization is, it fades relatively quickly. In a few cases (and in one of my discograms), the procedure flared-up the pain syndrome. Not the horrible stab up on pressurization, but just a general flare, somewhat worse for a week or more. In most cases, it’s over by the time you put your clothes back on.

Good luck… please keep us posted as you make progress. All the best,

Mark

[jsewell]

Mark,
I was one of the patients that was so frazzled by the first disc tested, I said it was a 20 out of 10, that i was not able to give accurate results for the remaining discs. I knew exactly what you meant by that sentence.
Judy

[Maria]

ArmyWife..
Had to laugh there re the F word... I said it with each discogram.. I remember screaming STOOOPPPPPPP during the 2nd one. My L5S1 wasn't tested the 1st disco cuz the Ortho thought it was so bad he didn't want to aggravate it.. the next 2 discos they tested it.. it was the last disc tested and a 10/10. I think the procedure rooms were far away from waiting area so people can scream.. now that is good planning.

A few weeks back was in my podiatrist's office for post surgical bunionectomy check and she bent my toe backwards .. I let out a serious YELP and she was sort of flustered because the waiting room is right outside the exam room... I was NOT apologetic!!!!

[karreymetris]

What does this entail exactly? This doesn't sound pleasant!

[mmglobal]

First, they'll place needles into each disc that will be tested. the doctors that use heavy sedation will do this while you are knocked out. When all the needles are in place, they will bring you around and ask you questions to make sure you are lucid.

Then, they will inject contrast into the first disc while watching on a flouroscope (real time xrays). They get multiple pieces of data from this. They can see where the contrast goes. This lets them know how serverely degenerated the disc nucleus is. Healthy disc material will absorb the contrast giving a 'cotton ball' appearance with the contrast forming a cloud in the middle of the disc. Severely degenerated nucleus will quickly find it's way out instead of being absorbed into the nucleus. You can see how tough and stringy the nucleus is. You can see the annular tears. You can see where the contrast runs out through the open tears. You can see the outline of structures in the canal area as the contrast outlines them (if there are open annular tears.)

As important, or even more important is the appearance of the contrast and how it moves through the system, is the provocation of pain. When they inject the contrast they pressurize the disc, recreating some higher pressure that you may feel when you sneeze, slip, etc... If pressurizing the disc provokes pain, they will ask you if it is YOUR pain... is this what you experience when you feel YOUR pain? That would be described as concordant pain that gives higher confidence in the result.

10/10 concordant pain from the degenerated discs, but 0/10 in a 'control disc' would indicate a positive result.

One problem with discography is that it is a 'double subjective' test. It relys on the doctor's subjective assessment of your subjective assessment of your pain. We have difficulty interpreting the results when you get ambiuous results... like 6/10 'maybe concordant' pain, or out of control pain responses when the needles are being placced or control discs are being pressurized.

Some doctors will use pressure manometry and will plot the pressures with the pain responses. Something like "opening pressure, 18 psi, pain began at 45 psi, the patient reported 10/10 concordant pain and the test was stopped at 85 psi with a firm endpoint.

The firm endpoint indicates that the doctor could not increase pressure and that it was solid. If there are big annular tears that allow the contrast to escape, it may be impossible to generate much pressure.

The test is somewhat controversial. Most of the doctors I know who do not embrace discography do so based on outdated information. The doctors I know who use discography do not view it as the ultimate decider and understand the limitations of the test. It is just another source of information. Well done, well documented tests with conclusive results are easy to have confidence in. Poorly done or poorly documented tests with ambiguous results don't carry much weight.

I hope this helps,

Mark

[karreymetris]

Oh my gosh, that sounds horrible! 10/10 pain sounds bad, but after childbirth, I feel like I can handle anything!

[mmglobal]

The 10/10 pain you get from discography lasts seconds.

The pain you get from childbirth lasts a lifetime!!!

Papa

[Maria]

They can give you something after the discogram is done like Marcaine injected into the area .. that really does help w/the pain. Also if you can get an epidural steroid injection authorized post procedure if they've helped you in the past that has a longer lasting effect tho I found the Marcaine to work really well. Even a Toradol injection would probably help.

[jsewell]

As Mark said, my discogram pain, although worse than childbirth, did last only a short time. I remember joking with the surgeon in the parking lot after the procedure.
Judy

[Maria]

What Judy and Mark stated is true re the pain only lasting a second tho if you have something to do right afterwards or have to travel to get home or ?? if you're back is flared up and you have the discogram done it may feel more flared up or it might feel better tho you will probably have a period of time that your back is going to be disgruntled afterwards if you're aleady experiencing pain. Just it won't be that sharp sudden pain that the discogram pressure forces it to (if the disc is concordant for pain).

So still I'd ask about getting something behind the discogram like Marcaine if you're not allergic to it because it's easy enough to be done after the procedure. It's like getting lidocaine in your mouth for dental work (only you'd not get it before the procedure).

Don't stress on the pain part of the discogram..

[karreymetris]

I feel like I have slight PTSD from childbirth

[joemonfl]

Yes I've had the worst pain I've ever had when a discogram was done at Methodist Hospital in Dallas Tx. Someone said a 20 out of 10 and I agree.

With that said, I had another one done which I had to be convinced was worth while & was not close in pain.

The doctor does not need to 'over pressurize' the disc to the point you scream like never before & keep it that way for a 'prolonged period'.

All that needs to be done is to add pressure if/until it causes a pain response. They can withdraw the fluid instantly and the pain goes away immeadiately.

SO PLEASE, don't be afraid of the test, make sure you talk/demand of your doctor how the test should be performed.

[jsewell]

Hi
I was the one who said it was a 20 out of 10 ! The good thing is it is such a short lived pain. I just moaned instead of screaming and cried a little.
But it did point out the correct disc to be removed and my thoracic pain has been gone since shortly after the surgery to remove it.
So it is a very good test
judy

[Stingerlee]

Originally Posted by real_army_wife

Hi there! I'm new here, so I'm sorry if I'm breaking any rules! I tried making sure I wouldn't, but it's hard to navigate from my iPhone.

Two days ago, I had a discogram to test my 3 bad discs (lumbar). If you do not want to be scared before yours, stop reading now. I am the type that likes to over hype myself, so I know what I'm getting into. Let's put it this way- I've given birth to 4 kids. I've had gallstones. I've had my large toenail surgically removed without the lidocaine working. I researched this procedure, as well as know off hand, as my husband has had one. I was so "hyped", my BP was 188/115. Let's just say that the discogram was the WORST pain Ive ever felt. I sobbed, screamed, almost fell off the table, and said the "F word" at least a dozen times, something unusual for me. It turns out that L 3-4 is a grade 5 (the worst) and L4-5 and L5-S1 are grade 4. Rated all at 10/10 pain, but the grade 5 was a 50 out of 10. The Dr said its likely that a 3 level fusion is what's required, but my "real appt" isnt until the 25th to speak to the surgeon team, who are rated 6th in the US. My question is, will the recovery from the fusion be as bad as the discogram? How would you compare the recovery? The night of, I was still in excrutiating pain that dilaudid was not helping. Here is a little more back ground for those of you that can hopefully help!

In 99, at 19, I injured by back. 3 discs were bulging per the MRI. In the last year, it has gotten in tolerable. An MRI last year said I had have 3 herniated/torn discs, spinal stenosis, facet athropy, and SI joint issues. After numerous PT, injections, etc, I decided to go through with the discogram. My husband was wounded and disabled in Iraq, and went this road. I remember how painful his discogram was. Then his 2 level fusion had complications, leaving him in a wheel chair for 2 years, ultimately having to retire from the army at 30. Of course that had me against the fusion for a while. Then came this, and I cannot function without major meds, and a cane everyday. I have 4 children, and am only 32. They say a 3 level on a 32 year old is a terrible thing. But my surgeon said all 3 were too bad to salvage. They've initially said that they would go through my stomach (even though as a woman, Id rather not have a scar there. Would that make recovery easier or harder than through the back? Anyhow, please be honest. Even if it's bad. I'm also in a rush to have this done before school starts the end of August. Pushing it, I know.**Thanks for reading. Have a great day!

Ask your surgeon about this and get another opinion.

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Disc decompression- Coblation

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