Can magnetic resonance imaging accurately predict concordant pain provocation during provocative disc injection?
From: Skeletal Radiol. 2009 May 9. [Epub ahead of print]
To correlate magnetic resonance image findings with pain response by provocation discography in patients with discogenic low back pain, with an emphasis on the combination analysis of a high intensity zone and disc contour abnormalities. Sixty-two patients (aged 17-68 years) with axial low back pain that was likely to be disc related underwent lumbar discography (178 discs tested). The magnetic resonance images were evaluated for disc degeneration, disc contour abnormalities, high intensity zone, and endplate abnormalities. Based on the combination of an high intensity zone and disc contour abnormalities, four classes were determined: (1) normal or bulging disc without high intensity zone; (2) normal or bulging disc with high intensity zone; (3) disc protrusion without high intensity zone; (4) disc protrusion with high intensity zone. These magnetic resonance image findings and a new combined magnetic resonance classification were analyzed in the base of concordant pain determined by discography.
Disc protrusion with high intensity zone correlated significantly with concordant pain provocation. A normal or bulging disc with high intensity zone was not associated with reproduction of pain. Disc degeneration, disc protrusion, and high intensity zone were not helpful in the identification of a disc with concordant pain. The proposed magnetic resonance classification is useful to predict a disc with concordant pain. Disc protrusion with high intensity zone on magnetic resonance imaging predicted positive discography in patients with discogenic low back pain.
