Lumbar diskogenic pain, provocation diskography, and imaging correlates

Diskogenic pain refers to pain mediated by the intrinsic innervation of the intervertebral disk. It is experienced as pain centered at the symptomatic spine segment (axial pain) without radicular features or radiculopathy. There is no pathoanatomic gold standard; histologic examination cannot identify a painful disk. The current reference standard for diskogenic pain is provocation diskography. This article reviews diskogenic pain, the history of provocation diskography, and its current use in the diagnosis of lumbar diskogenic pain. The extensive literature describing imaging features which may predict a positive diskogram, and allow non-invasive diagnosis of diskogenic pain, is examined.