I recently had a discogram and ct scan. The results conflicted one another. The Dr. that did the discogram noted L-4 was damaged but the ct scan show it being normal but it was L-3 with a grade 5 annular tear and L-5 grade 2 tear. The neurosurgeon released me saying I was not a good candidate for surgery because there is no conclusive results.
Anyone have advise on where I go from here?
Past MRI showed bulging discs @ L-123&5 and Spond and stenosis
Why are these tests giving different results?
Is one test better than the other?
If your symptoms are bad enough to make you consider surgery, and conservative measures have been tried and failed, I would suggest you consult with another spine specialist from a different practice/program.
Discograms are usually a confirmation of a diagnosis that the surgeon has already determined. Usually that is reached by various imaging techniques, the physical and basic neurologic exams and whatever you tell the doctor about your symptoms and how they impact your life.
It doesn't make sense that the CT scan would show different results. It was done immediately after the discogram, right?
The discogram is a subjective test, at least to some extent, and is considered controversial for that reason, and due to the fact that it is so invasive. It depends to some extent on the patient's responses.
Obviously you must have had much more pain when L4 was injected and responded accordingly. Annular tears can be present without the patient experiencing any pain, so perhaps that is true in your case, too. Just because you didn't react strongly when those levels were injected suggests that there is little nerve involvement, not that the disc is undamaged.
The CT scan shows what it can pick up through imaging. Perhaps there is nothing clearly visible at L4 or it appears to have a slight bulge, but due to the location of the bulge it is particularly irritating to the nerve, and is much more sensitive.
The main things a discogram indicates is the patient's reaction when each disc is injected, and whether the disc holds the liquid dye or whether there are cracks and fissures and the dye leaks out.
I know someone who didn't feel anything different from disc to disc -- none of the exam was particularly painful...and yet she had two discs that were quite damaged.
Discograms are often done to reassure a surgeon that he/she will be operating on the disc that is actually causing the pain. Sometimes it is difficult to determine which spinal segment is responsible for the person's pain. For example, in my own case, everyone thought most of my pain was coming from instability at l5-S1, but, when the surgeon opened me up, he discovered my facet joints at L3 were completely worn away, something that was not visible on the MRIs.
It sounds like you need to see another surgeon to see if he/she reaches the same conclusion as your surgeon...or you can just wait. Unless your spine heals on its own, eventually it will become clear where the problem is coming from.
The Following User Says Thank You to teteri66 For This Useful Post: sharkattack (06-22-2012)
thanks for the info. It makes a lot of sense what you are saying. I will be getting a second opinion. The problem that I am running into is it is a Workman's Comp case, 5 years old, and until I got a lawyer 2 1/2 years ago I had little care. I have been in pain for this long and did not want to get surgery but I also cannot live like this. I work in a busy kitchen which really takes a toll on my back. It is not all glamour like the Food Network, it is tough work.
You might want to get a second opinion from a fellowship-trained orthopedic spine surgeon (someone who only works on necks and backs). Their training is almost identical to that of a neurosurgeon's but they sometimes approach problems slightly differently.
If you haven't done so already, be sure to get copies of all imaging and tests and keep your own file. It comes in very handy when getting second opinions are having to provide results to insurance carriers, etc.