Stemcelldoc's Weblog

February 10, 2010

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.

March 16, 2009

Lumbar Discography

Lumbar Discography is a pre-surgical procedure to identify whether one of more of the lumbar discs is a “pain generator’.  It is a procedure that should only be undertaken if all other possible sources of pain have been excluded and the patient is prepared to undergone surgery.  Other sources of lower back pain include lumbar facets, sacroiliac joint dysfunction, ligamental instability and trunal dystonia.  At the Centeno-Schultz Clinic we are committed to evaluating all possible sources of pain prior to proceeding with discography.

Lumbar discography involves placing a needle under sterile conditions into the center of the disc at two or more levels.  For example, one would place one needle at the L5/S1 level and another at the L4/5 level.  Once the needles have been successfully placed, a small but increasing amount of pressure is applied to a single disc by injecting contrast through a hand held manometer.  The patient is awake and asked a series of questions which include whether or not the increasing pressure recreates his or her daily pain.lumbar-disco

A surgeon will use this information to plan the appropriate surgery.   A lumbar fusion is most common, involving one or more levels where the supporting muscles are resected from the bone and the lumbar disc is removed and replaced with bone.  Screws and rods are often utilized to stabilize the fusion.

Lumbar Fusion with Hardware

Lumbar Fusion with Hardware

An alternative is to use bone marrow-dervied stem cells to regenerata the disc.  Regenexx is a simple needle-in, needle-out procedure which allows the patient to forgo the risks of surgery, anesthesia and the extensive and painful rehabilitative period. Regnexx enables a patient to use their own stem cells thereby eliminating the risk of disease transmission and rejection.

Please review the MRI below of a patient who had undergone lumbar surgery without reduction in their pain. The L5/S1 disc is outlined by the dashed circle.  The picture on the left is pre-procedure whereas the image on the right is 13 months after injection of patient’s own stem cells.  Note that the disc has gone from dark (dehydrated) to bright(holding onto the fluid).  The more the disc is able to hold onto water, the better the disc is able to absorb the forces of daily activity. Finally the red arrow on the left,  points to a disc bulge which contacted the traversing nerve root.  13 months after therapy, as seen on the image on the right, the bulge and nerve root irritation is gone.

Axial Images Pre and Post Stem Cell Therapy

Axial Images Pre and Post Stem Cell Therapy

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