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Pain provocation at lumbar discography as analyzed by computed tomography/discography
Spine
|November 1, 1992
Summary
Lumbar discography revealed that disc degeneration has little relation to pain provocation. However, herniated nucleus pulposus, especially with specific extrusion types, strongly correlates with pain provocation in patients.
Area of Science:
- Orthopedics
- Radiology
- Neurosurgery
Background:
- Lumbar discography is a diagnostic tool for low back pain.
- Understanding pain provocation is crucial for diagnosing discogenic pain.
Purpose of the Study:
- To investigate the relationship between pain provocation and intradiscal deterioration.
- To evaluate pain provocation in relation to herniated nucleus pulposus and spinal canal stenosis.
Main Methods:
- Analysis of pain provocation in 1477 intervertebral discs from 523 patients using lumbar computed tomography/discography.
- Assessment of general degeneration and anular disruption using the Dallas Discogram Description.
- Categorization of discs based on clinical diagnosis.
Main Results:
- Pain provocation showed minimal correlation with intradiscal deterioration.
- A strong association was found between pain provocation and herniated nucleus pulposus.
- Specific herniated nucleus pulposus characteristics (extraligamentous extrusion, large protrusions, nerve root involvement) correlated with high pain provocation.
- Discs associated with spinal canal stenosis exhibited very low pain provocation ratios.
Conclusions:
- Intradiscal deterioration is not a primary driver of pain provocation in lumbar discography.
- Herniated nucleus pulposus, particularly specific types, is strongly linked to pain provocation.
- Spinal canal stenosis is associated with low pain provocation, suggesting different pain mechanisms.