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I'm curious to find out how many of you have had a discogram that shows disc damage when an MRI and myelogram showed the disc was fine.

I have had nasty sciatica for about a year now along the S1 nerve, and had a laminectomy/discectomy at L4/L5 last August which did not fix my pain even though the L4/L5 disc was bulging. A recent MRI and myelogram showed that the L4 and L5 nerve roots are compressed by my L4/L5 disc which is now really ugly after surgery, but the S1 nerve root looks fine as does the L5/S1 disc. I have had an orthopedic spine surgeon and a neurosurgeon say that the problem is not in my spine, but I am working with a physiatrist who consulted with the radiologist who read my most recent MRI and myelogram, and they both say it is my spine and think I should have a discogram as long as I am willing to have additional surgery to fix the problem.

This is soooo frustrating - I just want to scream and pull my hair out!
Hi

I have seen 3 different surgeons, and all had slightly different interpretations.

My MRI did say that my L4-L5 disc had an annular tear, bulge, and DDD. However, it did look much more normal to me than did my L5-S1 disc, which is herniated. My discogram showed that pain was coming from that disc (L4-L5). The first surgeon I saw was going to do a 2 level fusion (L4-S1) because of what the discogram said. The second surgeon said that disc looked completely normal and that discograms are bogus. The third surgeon (the one who is doing my surgery) does not think my pain is coming from that disc and is only doing a one level fusion.

So, I am just as confused as you.
My doctor recently told me that some people with the most horrible looking backs sometimes dont cause them any pain at all.
Can't sciatica be caused by compression outside of the spine at the Piriformis muscle? I think this is called Piniformis syndrome - did that get ruled out as the cause?
Hi brendaks1,

I have had a Ct scan, MRI and a Discogram. ON my Ct scan and MRI, both those test revealed disc issues as well as other issues gioing on in my back. After going through MONTHSSS of PT, injections, RF ablation < I think thats all ha> with my pain mgt doc...I had an appt. with my neurosurgeon. He informed/recommended a 2 level ALIF surgery BUT told me that, if I would feel better making the decision of having a fusion surgery, to have a discogram. Well, I did. I had NO idea LOLOL what I was getting myself into. I had never even heard of that test before. The discogram was scheduled a week or so later. I had instructions on what to do before arriving for the test ect. In the mean time, I drove myself literally crazy doing way too much reading about it. On the day of the test, I arrived. I was given an IV with a small bag of antibiotic.I was brought back into the room where the test is done The nurse injected IV with some sedation. It didNOT knock me out.....altho, I really dont remember much of what was going on. My doc injected the 1st disc, NO PAIN NO NOTHING. 2nd disc......well, it was PAINNNNNNN, 3rd disc, samething, PAIN. I was then brought to a recovery area....vitals taken and I had to wait for a short period of time and then I had a CT scan that followed.

After all this was completed, my pain doc came to talk to me. He told me that when he injected L4-5, the dye squirted out everywhere. It should stay within the disc He also told me I need that fusion. Both L4-5 and L5-S1 was in really bad shape and it was a matter of time beofre it was going to happen anyways. I had several tears in the linings of both my bad disc......

I went to my next appt.< after the discogram> with my neurosurgeon and he told me when he looked at the CT scan the dye ended up all on the outside of both those disc and I did indeed need a fusion. I actually didnt have much disc left at L4-5.

I can say in my own particular case, the discogram showed that my disc was way worst than the MRI and Ct scan both. The disc is outlined by the dye showing the complete anatomy of the disc. So, with Meggs doc saying it is a bogus test, I DONOT see how this test can be bogus if it is done like I had it done. I am glad I had that test done as I didnot want a uncessary major fusion surgery done. I had my fusion done on dec. 16, 2008 and so glad I did :) Good luck to you,

LYNN
Thank you for all of your responses and for sharing your insight.

Neckpatient - the neurosurgeon I saw said he thought it might be piriformis syndrome, but the physiatrist and radiologist are saying they don't think that is the case since my pain is so clearly along just the S1 nerve all the way into my foot and out my toes. They said with piriformis syndrome it is a more diffuse sciatica and rarely goes below the knee, and if it does it affects multiple nerves, not just one like I have. They are saying it is acting much more like a disc problem even though the MRI and myelogram show that my L5-S1 disc looks fine.

I have been told so much conflicting information from so many doctors, I just don't even know who to believe anymore and feel very confused.
No kidding it is so easy to get confused by all this, and 4 different doctors can have 4 different opinions sometimes.

Based on what you said: You had a laminectomy/discectomy at L4/L5 from a bulging disc at L4/L5. New MRI and myelogram show L4 and L5 nerve roots are compressed by L4/L5 disc (new bulge????) which is now really ugly after surgery, but the S1 nerve root looks fine as does the L5/S1 disc.

QUESTION:
1. why don't they suspect maybe a disc fragment from any of these discs that maybe they can't see - this is really common where a disc might have a tear, leak material out, seal itself over time and look fine on MRI, only to surprise the surgeons when they go in there. Is it possible this type of fragment is irritating that S1 root?

2. You have no bone riding or bone spurs at the previous fusion level?

COMMENT: You could go through the process of having the discogram and get lucky, we already know L4 is going to show some damage, so the discogram will give you information on L5, S1. If nothing shows you come back to square one.

P.S. on the pirifornis - you know there is always a person who shows symtpoms outside of the "average" so are there any tests or nerve blocks that can be done outside of the spine to check for that syndrome?


That's all the ideas that I have on this. NP





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