Fear of discography?

mmglobal · #1 (**permalink**) 03-31-2008, 10:45 AM

Diane's surgery blog has generated a lot of discussion about discography. Much of it concerns our (almost) overwhelming fear of the procedure, to the point where it may have an impact on our decision making process. Then, we disover that it was really no big deal. That's the recent discussion, but past discussion has been about how horrific discography can be.

I'd like to provide a little balance here. I've had discography performed on me 4 times (3 lumbar, 1 cervical). I've been in the OR, often holding the patient's hand for discography almost 50 times.

My personal experience:

1. Lumbar discography - "It's not that bad", but I truly believe that the report is blown. I remember concordant pain at 2 levels. At the time, I have no knowledge of spine issues, but I remember driving away from hospital sure that I was going to have a 2-level fusion. In retrospect, blown report saves me from having the wrong surgery and I'm glad.

2. Lumbar discography - Procedure was not that bad, but it flares me up for many days. Worse than that, a few weeks later (2 or 3), I have a massive disc protrusion at the 1 discographied level. In retrospect, discography probably pushed already incompetent disc over the edge... an unlikely result, but still a good reason not to do discography unless you are prepared to have surgery.

3. Lumbar discography... 4 levels... zero sedation. This was tough and Dr. Zeegers was very motivated to prove 2nd level OK, so he retested and retested. At one point he stopped and said, "Mr. Mintzer, there are other patients waiting outside and you are frightening them." This torture is a necessary evil and I'm very glad that we got unambiguous results and a 2-level ADR was done.

4. Cervical discography - 3 levels - all positive... just a couple of months ago. Again... not that bad. I was able to function well after the test... flew home (Munich to Los Angeles) a couple of days later and actually felt better than usual for a few weeks. (Rehydration of the discs?)

Remember that potential complication from these procedures are rare, but they do happen. I've had clients with meningitis (1) and severe spinal headaches (many) from myelograms. I've had clients get discitis (VERY SERIOUS) from minimally invasive nucleotomy. While we must understand the risks, for those of us considering spine surgery, the diagnostic value of discography can be huge.

While many discography experiences are easy... many are not. The people who post the horror stories are not babies... they just had a bad experience with their test. But, what I believe is that if you do have a bad experience... or if it does set you off for a few or even many days... IT'S ALL JUST A FEW MORE DAYS IN HELL. It's what we live with all the time anyways. If it brings us closer to a solution, bring it on. Obviously, the indications for doing the test must be clear, but if you need it... don't let the fear of the test keep you from getting the best diagnostics possible.

One thing that is VERY frustrating is getting ambiguous discography results. I've read hundreds of reports... frequently during doctor appointments. Often, the doctors can't take any value from ambiguous results, poorly performed tests, or poorly written reports. Worse than that, I've seen ambiguous discography results written up as only clear positive and negative levels. In my experience... clear concordant pain went in the books as non-concordant.

Discography results can be wrong or ambiguous. It only represents a piece of the puzzle. Many nay-saying doctors don't believe in discography because of the potential for error. I see it used, very effectively, by the doctors who know how. We understand the shortcomings, but it often sheds very important light on a confounding situation.

I loved Dales 'fear of opening envelopes' comment on Diane's thread (below). Please post your experiences.

All the best,

Mark

Some other discography topics on iSpine: