discogram question

[john70]

i am 38 year old 6ft 190lbs. motorcycle accident 2 years ago. had surgery on herniated disk L5-S1
i still have alot of pain so i had a discogram these are the results. some doctors sujest fusing atleast 3 levels.
are these that results bad?
thanks for any informatiom

CT SCAN OF THE LUMBAR SPINE POST DISCOGRAPHY AND IMAGES FROM A
DISCOGRAM PROCEDURE-

The C-arm images from the discogram demonstrate contrast material at
the L3-4, L4-5, and L5-S1 intervertebral discs. The post discography
CT scan demonstrates contrast material at the L3 level to diffuse
throughout a diffusely degenerated intervertebral disc. This
material fused out to the peripheral edges of the degenerated and
broadly protruding disc. Contrast material also extends upward into
a Schmorl's node through the inferior endplate of L2. Contrast
material at the L4-5 level also diffuses throughout an abnormally
and diffusely degenerated intervertebral disc. The material extends
out to the peripheral margins of a degenerated and protruding disc
especially to the left of midline. The contrast material at the L5-
S1 level is also noted to diffuse throughout the degenerated disc
out to the outer margins especially on the right side. There is a
small amount of contrast material extravasating into the right
foramen.

IMPRESSION-

1. ABNORMAL DISCOGRAMS AT L3-4, L4-5, AND L5-S1. ALL THREE
OF THESE DISCS ARE DIFFUSELY DEGENERATED WITH CONTRAST
MATERIAL DIFFUSING THROUGH THE OUTER MARGINS OF THESE
DEGENERATED AND PROTRUDING DISCS. IN ADDITION, THERE IS A
SCHMORL'S NODE AT THE INFERIOR ENDPLATE OF L2.

[Paul J Slosar]

Dear John, quilter is right in that a 3 level fusion is a tough one to recommend to any patient especially at the age of 38.
Regarding your discogram, it is not exacly enough information to understand it completely.  The most important information is not the radiologists's reading as you have listed.
The actual responses to the injections that the injection doctor would record is VERY important.  Specifically, do you have a normal level (control level) that is normal on MRI and was NON-painful on disco?  Did injection of L34, L45, and L5S1 all produce severe, concordant (matching) pain to the pain you experience daily?

Only very sophisticated spine surgeons with discogram experience can give you comprehensive advice regarding these results and the surgery issues.  I personally have many 3 level fusion success cases but I am very selective about making such a surgey suggestion to patients that I know can handle the surgery and the recovery.
Good luck

[quilter54]

Oops!  I didn't realize I was in a "ask the doctor" forum!  Obviously, I'm new in town.  Hope you get an answer -- I'm not a doctor.

[quilter54]

Hi John - well, it's nice to know that I am not alone.  Yes, it sounds as though your discs are severely smashed - so much so that the dye they injected sort of leaked out everywhere.  I don't know if you will find someone to do a three-level fusion.  Most doctors generally recommend against them.  My spine is about as badly damaged as yours is in the same places and, after being told there was nothing to do for me besides a spinal cord stimulator, I have found a good (I think) surgeon who will do my 3-level fusion next month.  Am I looking forward to this?  No.  It will not be an easy surgery and there is a chance that much fusion will put too much strain on the discs and vertebra above and I will have more troubles later on.  However, I am in physical therapy and not getting better and my symptoms get worse each week.  My surgeon feels that, because of the arthritis I also have, my spine will not fuse well on its own.  You will need to decide if you can tolerate your pain levels (I know I can't and I'm on some mega-drugs) and if you do have the surgery, if you're prepared to do your best to stay physically fit and have your muscles support your spine in years to come (I am).  I wish you the very best.  I understand what you're going through as I have damage at the same levels -- discs torn through from side to side and my dye leaked out too.

Linda