Technology Insight: imaging of low back pain

Chronic low back pain is a common condition that has significant economic consequences for affected patients and their communities. Despite the prevailing view that an anatomic diagnosis is often impossible, an origin for the pain can frequently be found if current diagnostic techniques are fully used. Such techniques include a mixture of noninvasive and invasive imaging. Prevalence data suggest that the intervertebral disc is one of the most common sources of back pain, accounting for around 40% of cases. The pathologic basis for discogenic low back pain might be full-thickness radial tears of the annulus fibrosus. Unfortunately, only MRI can image the internal morphology of the disc, and both CT and MRI lack the necessary specificity to validate this hypothesis. Many so-called radiographic abnormalities seen on CT and MRI are commonly encountered in asymptomatic individuals. Invasive techniques such as joint injections, nerve blocks and provocative discography can show the connection between an abnormal image and the source of low back pain, but do have notable related risks. The development of a noninvasive, low-risk technique that can show this connection is desirable.