Clinical and Radiological Findings of Discogenic Low Back Pain Confirmed by Automated Pressure-Controlled Discography

Abstract

Objective : Few studies on the clinical spectrum of automated pressure-controlled discography (APCD)-defined positive discs have been reported to date. Thus, the present study was undertaken to analyze clinical parameters critical for diagnosis of discogenic pain and to correlate imaging findings with intradiscal pressures and pain responses in patients with APCD-positive discs. Methods : Twenty-three patients who showed APCD-positive discs were selected for analysis. CT discogram findings and the degrees of nuclear degeneration seen on MRI were analyzed in comparison to changes of intradiscal pressure that provoked pain responses; and clinical pain patterns and dynamic factors were evaluated in relation to pain provocation. Results : Low back pain (LBP), usually centralized, with diffuse leg pain was the most frequently reported pattern of pain in these patients. Overall, LBP was most commonly induced by sitting posture, however, standing was highly correlated with L5/S1 disc lesions (p < 0.01). MRI abnormalities were statistically correlated with grading of CT discogram results (p < 0.05); with most pain response observed in CT discogram Grades 3 and 4. Pain-provoking pressure was not statistically correlated with MRI grading. However, it was higher in Grade 3 than Grade 4. Conclusion : APCD-positive discs were demonstrated in patients reporting centralized low back pain with diffuse leg pain, aggravated by sitting and standing. MRI was helpful to assess the degree of nuclear degeneration, yet it could not guarantee exact localization of the painful discs. APCD was considered to be more useful than conventional discography for diagnosis of discogenic pain.

An Update of Comprehensive Evidence-Based Guidelines for Interventional Techniques in Chronic Spinal Pain. Part II: Guidance and Recommendations

“…In addition, aging causes fissures and tears in the annulus. Further, there are also multiple types of chemical changes that occur in the degenerated discs with the release of inflammatory substances (571)(572)(573)(574)(575)(576)(577)(578)(579)(580)583,669,670,(673)(674)(675)(676)(677)(678)(679)(680)(681)(682)(683)(684)(685)(686).…”

“…Thus, the role of various chemicals and inflammation has been extensively investigated with discogenic pathology and radicular pain (28,30,31,36,309,(571)(572)(573)(574)(576)(577)(578)(579)(580)583,(681)(682)(683)(684)(685). The complex mechanism of discogenic pain includes chemical nociception leading to low back pain with or without disc herniation (8,378,380,577,642,1471,1594,(2182)(2183)(2184)(2185)(2186).…”

Discography

“…Opening pressure is noted when the dye is visualized in the disk space. 13 If pain is elicited at pressures < 15 psi, the disk is considered to be chemically sensitive.…”

Vibration Diagnostic Probe for Discogenic Pain Due to a Fissure in an Annulus Fibrosus

“…Despite controversy regarding the accuracy and specificity of discography, it is recognized as the only method of proving the diagnostic standard for discogenic pain. Discography is known to provoke pain by pressing onto nerve structures around the fissures through the injection of contrast media (Shin et al, 2009). However, intradiscal pressure cannot be increased to provoke pains because severely degenerated discs cannot entrap contrast medium inside the discs (Kim et al, 2009); (Adams et al, 1986).…”

“…Discography is known to provoke pain by pressing onto nerve structures around the fissures through the injection of contrast media (Shin et al, 2009). However, intradiscal pressure cannot be increased to provoke pains because severely degenerated discs cannot entrap contrast medium inside the discs (Kim et al, 2009); (Adams et al, 1986). Therefore, discography has practical limitations in patients with severely degenerated discs.…”