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Theraupatic Lumbar Discogram?

Lumbar discography is procedure in which a needle is placed into the disc at two or more levels to determine whether of not a specific disc is the  source of pain.  Is the pain coming from the L4/5 disc or the L5/S1 disc?  The procedure is performed with intermittent x-ray.  Once the needles are in the center of each disc,  contrast is injected into the disc.   A patient’s response is graded as follows:

P0:  no pain:  a common response in a healthy disc

P1:  painful, but not identical in quality or location to the patient’s daily pain.

P2:  painful, identical in character, quality and location.

Discograms are strictly a pre-surigcal procedure which tells the surgeon which level to operate.  They have no therapeutic benefit.  I have had two discograms and they HURT!

A recent study demonstrated that lumbar discograms accelerate disc degneration.

Patients are often  misinformed about discograms.

AJ was a 23y/o with 6 month history of low back pain following a rear-end motor vehicle injury.  Pain was constant in duration, 6/10 in severity, progressive in nature and  localized in her lower back, right =left with radiations into her buttocks.  MRI was significant for mild degeneration of the L5/S1 disc. Physical examination was significant for tenderness in the lower lumbar spine with extension and rotation.  She had no treatment to date:  no physical therapy, chiropractic care, trial of good quality fish oil, massage or evaluation by a pain specialist.  Her PCP referred her to a surgeon for evaluation of her back pain.  She was scheduled for a discogram which she thought was going to help here back pain.

Evaluation of all possible sources of pain is essential.  For lumbar back pain common causes include:

  • myofascial: dysfunctional muscles
  • facet dysfunction:
  • ligamental dysfunction: treated with proloterhapy
  • SI joint dysfunction:
  • Disc dysfunction.

The Centeno-Schultz Clinic is committed to identifying the cause of a patient’s pain and designing an proper treatment plan utilizing state of the art therapies.

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