I have been in severe pain. My pain level is at a 10. I have had physiotherapy
, epiderals, facet blocks, and just had a discography that i actually fell asleep in. Following the discogram i was sent for a cat scan. I have burning, sharp pain along my spine and it hurts to take deep breaths and feels like knives are cutting through me. I have numbness and shooting pain running down my left leg into my feet. This pain has compromised my life to 0 quality. I can not sit or stand for longer than 10 minutes. Laying in a fetal position is the only modality that gives me little pain relief. My pain management doctor has me on quite a bit of pain medicine that gets me through. I am writing what my discogram says first, then my cat scan. Can you tell me if surgery will give me a better quality of life?
Patient was placed in prone position. Lower lumbar area was prepped and draped stairely. C arm was then angeled in right oblique projection and lidocaine 1% 5ml was used on the left side about 6 cm of midline at level of L 3 - L 4, level 4 - l5, level 5 - S1. The patient also has a transitional vertebra no discography was performed at transitional vertebrae because of technical difficulties. Double-needle technique was used and introducer was first passed and contact was made with superior articular processes at each of these levels. 22 gauge needle was then taken and it was passed through the introducer. Again, contact was made with superior articular process. Needle was then walked lateral to the superior articular process and to the disc. Both AP and lateral projections demonstrated needle to be in the midline of the disc. The patient was then injected with Omnipaque 300. Each mL of omnipaque had 10 milligram of keflex. At l3 l4 level, resistance to injection was appreciated at 0.5 ml. Total amount injected with 1 ml. Pattern of dye was cotton ball. This was normal disc. The patient reported no pain. At level 4 - level 5, resistance to injection was appreciated at 0. 5 a.m. Total amount injected was 1 ml. Pattern of dye was hamburger. This was normal disc. The patient reported very minimal concordant pain. At l5 - s1, there was no resistance upon injection. Total amount injected with 2.5 ml. This was degenerative disc with posterior fissur and clefts. The patient report moderate Concordat low back pain.. Needles were then removed. The patient tolerated the procedure well without any incidents and was taken to postanesthesia care unit in stable condition. The patient was given prescription for keflex 500 milligram 1 p.o. q 6 hrs.. Norco 10-325 one to two tablets p.o. q 8 hours PRN for pain, dispense a hundred fifty limit 150; limit 5 per day. MS Contin
100 milligram 1 p.o. q. 12 hours, dispebse 60. The patient was sent for post discogram CAT scan. IMPRESSION the patients Concordant low back pain is coming from L5-S1 level.
My question is: there was technical difficulty at the transitiinal vertebrae. Which disc is the transitional vertebrae? Doctor states he hit all levels, but states there was technical difficulty. My CAT scan shows something different. I fell asleep during discogram. Where is all this pain coming from? My pain is 5x worse after discogram. Here, below is my CAT scan:
I have tried every modality over the 5 years of excrutiating pain: would I be a candidate for spinal surgery/spinal fusion, ect.
CAT scan (with contrast)
Level 1 - level 2 mild disc bulge without significant central canal stenosis or neural foraminal narrowing. Level to level 3 disc bulge without significant central canal stenosis. Discograham grade 0, normal just without leakage of contrast material from the nucleus. Mild bilateral neural foraminal narrowing. Level 3 - level 4 disc bulge with a left foraminal broad - based disc protrusion without significant central canal stenosis. Grade 4 annular tear, contrast material extends to the outer third of the annulus and spreads cocentrically around the left posterolateral disc. Mild right and moderate left neural foraminal narrowing with mass effect on the left existing l3 nerve root. L 4 - L five broad - base right central disc protrusion causing mild central canal stenosis and mild bilateral neural foraminal narrowing. Grade 3 annular tear with contrast leaking through to the outer third of the annulus. L5-S1 No significant disc abnormalities. Moderate facet arthrosis without significant central canal stenosis. Mild bilateral neural foraminal narrowing.
1. Grade 4 annular tear at the l3 - L4 levels with a left foraminal broad-based disc protrusion. Mild right and moderate left neural foraminal narrowing with mass effect on the Left existing L3 nerve root. 2. Grade 3 annular tear at the l4-l5 level with a broad-based right central disc protrusion causing mild central canal stenosis and mild bilateral neural foraminal narrowing.
Last question: am i a candidate for a fusion or spinal surgery? Thank you!!!