Discogenic lumbar pain: association with MR imaging and CT discography

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Abstract

Objective:

To correlate MR and CT discography findings with pain response at provocative discography in patients with discogenic back pain.

Materials and methods:

Forty-seven patients aged 25–54 years who underwent MR imaging and subsequent CT discography (97 discs) were included in this study. MR images were retrospectively evaluated regarding disc degeneration, endplate abnormalities, facet joint osteoarthritis, and high intensity zone. During discography concordant pain was regarded as positive, whereas discordant pain and no pain were regarded as negative. MR and CT discographic findings were analyzed on the base of concordant pain using the Chi-square test.

Results:

Concordant pain was significantly common in the following (P < 0.05): grade 4 or 5 disc degeneration [88% (30/34) in concordant pain versus 48% (30/63) in discordant pain and no pain], high intensity zone [56% (19/34) versus 30% (19/63)], combination of above two findings [53% (18/34) versus 25% (16/63)], fissured and ruptured disc at discogram [94% (32/34) versus 57% (36/63)], and contrast beyond inner annulus at CT discogram [97% (33/34) versus 57% (36/63)].

Conclusion:

Typical MR findings with concordant pain at discography include grade 4 or 5 disc degeneration and presence of a high intensity zone. Typical CT discography findings with concordant pain were fissured/ruptured discs and contrast extending into/beyond the outer annulus on CT.

Introduction

Low back pain is the second most common complaint encountered by primary care physicians. In a small proportion of individuals, low back pain can be ascribed to nerve root compression. Most individuals with low back disorders, however, have symptoms of back pain, with or without referred pain, in the absence of objective neurologic signs [1]. One of the prominent somatic sources of low back pain is the internal disc disruption of the lumbar spine, discogenic lumbar pain. Discogenic lumbar pain is the condition causing back pain without radiculopathy [2].

The purpose of this study was to determine if discogenic lumbar pain is associated with computed tomography (CT) discographic and magnetic resonance (MR) findings based on pain response during discography.

Section snippets

Study population

The study population consisted of 66 patients who underwent MR imaging and subsequent CT discography. Discography was performed in patients who had disc degeneration without neural compression at prior MR imaging. Discography was not performed in patients who had disc extrusion, sequestration, spinal stenosis, spondylolysis, spondylolisthesis, spondylitis, or erosive osteochondritis. Patients (n = 19) who had undergone previous lumbar disc surgery were excluded from this study. There were no

Results

At MR imaging, disc degeneration was graded as follows: grade 1 (n = 2), grade 2 (n = 15), grade 3 (n = 20), grade 4 (n = 44), and grade 5 (n = 16). Slight decrease in disc height was observed in 22% (21/97) of cases: grade 3 (n = 3), grade 4 (n = 12), and grade 5 (n = 6). The distribution of the grades in disc degeneration is described in Table 1. The endplate abnormalities were observed in 14% (14/97) of cases: Modic type I (n = 6) and Modic type II (n = 8). Type III endplate abnormalities

Discussion

Most low back pain has a somatic origin of pain within the musculoskeletal tissues of the lumbar spine. The annulus fibrosus is innervated by the recurrent meningeal nerve and by the small branches from the ventral ramus of the somatic spinal nerve [9], [10]. If annular tears occur, these nerve endings may be irritated by acid metabolites contained in the herniating disc material. Pain reproduction at discography is associated with tears that extend to the outer part of the annulus. The pain

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