cervical discograms?

sahuaro · #1 (**permalink**) 02-03-2007, 01:12 AM

A cervical discogram has been prescribed for me but apparently there is some disagreement in the literature as to its usefulness. I would appreciate thoughts about this and experiences of other cervies. Thanks.

mmglobal · #2 (**permalink**) 02-03-2007, 06:10 AM

Sahauro... I've been in the OR for many cervical discograms, in the US and overseas.... I have to go now, but will post more later. There are many benefits to a properly done discography... but as with lumbar discography, the operator is critical. It's a shame that we didn't know you were going to have it when you were in LA. The imaging center I went to with a client was superior and the radiologist was excellent.

Talk to you soon... gotta run!

Mark

sahuaro · #3 (**permalink**) 02-03-2007, 10:03 PM

Thanks, Mark.
Actually, if I go this route, I may very well return to LA to have the discogram done. I remember feeling dizzy and just not well the day after my ESI's and despite trying to be active, had to spend the day chilling out at home--I don't know if this was a reaction to the procedure or sensitivity to the steroid.
I'd really appreciate hearing about others' experiences--that would help in planning a trip to LA. Thanks.

ans · #4 (**permalink**) 02-04-2007, 12:31 AM

Dr. Regan suggested that I see Dr. Fuller for a lumbar discogram and he's also a very nice guy. Another person I saw who's respected but a fast-talking New Yorker is Roy Simon in Westood. He's an interventional radiologist. Yes, come to LA!

mmglobal · #5 (**permalink**) 02-05-2007, 01:15 AM

I got back from Germany very late last night.... still exhausted.

Cervical discography is much like lumbar discography, but seems to be easier on the patient. My guess is because for those of us with lumbar discogenic pain, the pain is extreme. We have cervical discogenic pain, but I don't think it typically manifests itself with the severe axial back pain that the lumbies experience. (Less weight... lower pressures?) I also believe that the cervical discs are so much easier to reach that there is much less 'fiddle factor' and less pain generated during needle placement.

Interpretation of discography results is difficult for the same reasons... "Yes, it's painful, but is that your pain?" "Well... kind of, sort or like maybe." I've seen very clear results and also ambiguous results.

Like lumbaer, they pay attention to the dispersion pattern of the contrast material and also to the extravasation of the contrast out into the canal area. With much smaller spaces involved, it seems that the value of the flouroscopic images with contrast in the canal area is often more valuable than what I've seen in lumbar discography.

We usually think of discography as a provocative test that attempt to recreate an awake patient's pain. Many times I've seen interoperative cervical discography performed under general anesthesia during surgery. There is no opportunity here for pain responses. As mentioned above, the extravasation of the contrast into the epidural space provides valuable imaging. I believe that with the smaller spaces involved, posterior decompression and removal of posterior osteophytes is very critical. This 'epidurography' thats generated as a byproduct of the discogram helps a great deal.

As with lumbar discography, I don't believe it's completely risk free, so for myself, I would not submit to discography unless I was ready to act on the results. In most cases I've seen, discography is not used to determine if surgery is needed... it's used to determine how much surgery... which levels. If that's the case and your surgeon is one of those who will perform his own discography, I believe that the value of the discography performed by the surgeon is greater than the value of discography done by someone else.

I hope this helps. Remember... I'm a layperson... listen to my opinions at your own risk.

Mark

sahuaro · #6 (**permalink**) 02-05-2007, 05:12 AM

Thanks ans and Mark!
The option of intraoperative discography is appealing in some ways (if "appealing" is applicable at all!), except that you wouldn't know going in how much surgery you were going to have. It also means that you wouldn't have a CT scan after the procedure--what info does the CT add?

mmglobal · #7 (**permalink**) 02-10-2007, 01:07 AM

You have the flouroscopy done interoperatively that will provide the epidurogram (assuming there is extravasation of the contrast).

CT contains a lot of info about tissues that are not as visible on MRI, but you can do a CT anytime if it is deemed necessary. The advantage of the post-disco CT is the image of the dispersion of the contrast, and you get that with the flouroscopy.

All the usual "I'm not a doctor" disclaimer applies here. Perhaps someone paindoc will come along and shed some more light here?

Mark