Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
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Clinical and Radiological Findings of Discogenic Low Back Pain Confirmed by Automated Pressure Controlled Discography

  • Kim, Hyung-Gon (Department of Neurosurgery, Presbyterian Medical Center) ;
  • Shin, Dong-Ah (Department of Radiology, Presbyterian Medical Center) ;
  • Kim, Hyoung-Ihl (Department of Neurosurgery, Presbyterian Medical Center) ;
  • Yoo, Eun-Ae (Department of Neurosurgery, CHA University) ;
  • Shin, Dong-Gyu (Department of Neurosurgery, Presbyterian Medical Center) ;
  • Lee, Jung-Ok (Department of Neurosurgery, Presbyterian Medical Center)
  • Published : 2009.10.28
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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<005); 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.

Keywords

References

  1. Bogduk N : Low back pain in : Bogduk N(ed) : Clinical anatomy of the lumbar spine and sacrum. London : Churchill Livingstone, 2002, pp187-213
  2. Bogduk N, Modic MT : Lumbar discography. Spine (Phila Pa 1976) 21 : 402-404, 1996 https://doi.org/10.1097/00007632-199602010-00031
  3. Boos N, Rieder R, Schade V, Spratt KF, Semmer N, Aebi M : 1995 Volvro Award in clinical sciences. The diagnostic accuracy of magnetic resonance imaging, work perception, and psychosocial factors in identifying symptomatic disc herniations. Spine (Phila Pa 1976) 20 : 2613-2625, 1995 https://doi.org/10.1097/00007632-199512150-00002
  4. Carragee EJ, Tanner CM, Yang B, Brito JL, Truong T : False-positive findings on lumbar discography. Reliability of subjective concordance assessment during provocative disc injection. Spine (Phila Pa 1976) 24 : 2542-2547, 1999 https://doi.org/10.1097/00007632-199912010-00017
  5. Carragee EJ, Tanner CM, Khurana S, Hayward C, Welsh J, Date E, et al : The rates of false-positive lumbar discography in select patients without low back symptoms. Spine (Phila Pa 1976) 25 : 1373-1380; discussion 1381, 2000 https://doi.org/10.1097/00007632-200006010-00009
  6. Carragee EJ, Alamin TF, Carragee JM : Low-pressure positive discography in subjects asymptomatic of significant low back pain illness. Spine (Phila Pa 1976) 31 : 505-509, 2006 https://doi.org/10.1097/01.brs.0000201242.85984.76
  7. Carrino JA, Lurie JD, Tosteson AN, Tosteson TD, Carragee EJ, Kaiser J, et al. : Lumbar spine : Reliability of MR imaging findings. Radiology 250 : 161-170, 2009 https://doi.org/10.1148/radiol.2493071999
  8. Coppes MH, Marani E, Thomeer RT, Groen GJ : Innervation of 'painful' lumbar discs. Spine (Phila Pa 1976) 22 : 2342-2349, 1997 https://doi.org/10.1097/00007632-199710150-00005
  9. Derby R, Howard MW, Grant JM, Lettice JJ, Van Peteghem PK, Ryan DP : The ability of pressure-controlled discography to predict surgical and nonsurgical outcomes. Spine (Phila Pa 1976) 24 : 364-371; discussion 371-372, 1999 https://doi.org/10.1097/00007632-199902150-00014
  10. Derby R, Howard MW, Grant JM, Lettice JJ, Van Peteghem PK, Ryan DP : The ability of pressure-controlled discography to predict surgical and nonsurgical outcomes. Spine Feb15 : 24 : 364-371, 1999 https://doi.org/10.1097/00007632-199902150-00014
  11. Freemont AJ, Watkins A, Le Maitre C, Jeziorska M, Hoyland JA : Current understanding of cellular and molecular events in intervertebral disc degeneration : implications for therapy. J Pathol 196 : 374-379, 2002 https://doi.org/10.1002/path.1050
  12. Jung JH, Kim HI, Shin DA, Shin DG, Lee JO, Kim HJ, et al. : Usefulness of pain distribution pattern assessment in decision-making for the patients with lumbar zygapophyseal and sacroiliac joint arthropathy. J Korean Med Sci 22 : 1048-1054, 2007 https://doi.org/10.3346/jkms.2007.22.6.1048
  13. Kuslich SD, Ulstrom CL, Michael CJ : The tissue origin of low back pain and sciatica : a report of pain response to tissue stimulation during operations on the lumbar spine using local anesthesia. Orthop Clin North Am 22 : 181-187, 1991
  14. Laslett M, Oberg B, Aprill CN, McDonald B : Centralization as a predictor of provocation discography results in chronic low back pain, and the influence of disability and distress on diagnostic power. Spine J 5 : 370-380, 2005 https://doi.org/10.1016/j.spinee.2004.11.007
  15. Lee SH, Derby R, Chen Y, Seo KS, Kim MJ : In vitro measurement of pressure in intervertebral discs and annulus fibrosus with and without annular tears during discography. Spine J 4 : 614-618, 2004 https://doi.org/10.1016/j.spinee.2004.03.021
  16. Lee SW, Kim KN, Chin DK, Kim YS, Cho YE, Jin BH : Diagnostic significance of discography on multiple lumbar disk herniation. J Korean Neurosurg Soc 29 : 628-634, 2000
  17. Manchikanti L, Singh V, Pampati V, Damron KS, Barnhill RC, Beyer C, et al. : Evaluation of the relative contributions of various structures in chronic low back pain. Pain Physician 4 : 308-316, 2001
  18. Merskey H, N B : Spinal and radicular pain syndrome in : Merskey H, N B(eds) : Classification of cronic pain : Description of chronic pain syndrome and definition of pain terms, ed 2. Seattle : IASP, 1994
  19. Ohnmeiss DD, Vanharanta H, Ekholm J : Relation between pain location and disc pathology : a study of pain drawings and CT/discography. Clin J Pain 15 : 210-217, 1999 https://doi.org/10.1097/00002508-199909000-00008
  20. Pfirrmann CW, Metzdorf A, Zanetti M, Hodler J, Boos N : Magnetic resonance classification of lumbar intervertebral disc degeneration. Spine (Phila Pa 1976) 26 : 1873-1878, 2001 https://doi.org/10.1097/00007632-200109010-00011
  21. Schwarzer AC, April CN, Derby R : The prevalence and clinical features of internal disc disruption in patients with chronic low back pain. Spine (Phila Pa 1976) 20 : 1878-1883, 1995 https://doi.org/10.1097/00007632-199509000-00007
  22. Sehgal N, Fortin JD : Internal disc disruption and low back pain. Pain Physician 3 : 143-157, 2000
  23. Seo KS, Derby R, Date ES, Lee SH, Kim BJ, Lee CH : In vitro measurement of pressure differences using manometry at various injection speeds during discography. Spine J 7 : 68-73, 2007 https://doi.org/10.1016/j.spinee.2006.05.013
  24. Sharma A, Pilgram T, Wippold FJ 2nd : Association between annular tears and disk degeneration : a longitudinal study. AJNR Am J Neuroradiol 30 : 500-506, 2009 https://doi.org/10.3174/ajnr.A1411
  25. Shin DA, Kim HI, Jung JH, Shin DG, Lee JO : Diagnostic relevance of pressure-controlled discography. J Korean Med Sci 21 : 911-916, 2006 https://doi.org/10.3346/jkms.2006.21.5.911
  26. Shin DA, Kim SH, Han IB, Rhim SC, Kim HI : Factors influencing manometric pressure during pressure-controlled discography. Spine (Phila Pa 1976) 34 : E790-E793, 2009 https://doi.org/10.1097/BRS.0b013e3181ba2a8d
  27. Slipman CW, Patel RK, Zhang L, Vresilovic E, Lenrow D, Shin C, et al : Side of symptomatic annular tear and site of low back pain : is there a correlation? Spine (Phila Pa 1976) 26 : E165-E169, 2001 https://doi.org/10.1097/00007632-200104150-00026
  28. Tomecek FJ, Anthony CS, Boxell C, Warren J : Discography interpretation and techniques in the lumbar spine. Neurosurg Focus 13 : E13, 2002

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