Disc deterioration in low-back syndromes. A prospective, multi-center CT/discography study

Area of Science:

• Orthopedics
• Radiology
• Pain Management

Background:

• Low-back pain (LBP) is a prevalent condition with diverse etiologies.
• Accurate diagnosis of LBP syndromes is crucial for effective treatment.
• The role of intradiscal pathology in various LBP syndromes requires further elucidation.

Purpose of the Study:

• To investigate the relationship between disc deterioration, pain provocation, and different low-back pain syndromes.
• To assess the diagnostic utility of computed tomography (CT) discography in LBP patients.
• To determine the contribution of intradiscal pathology to nonspecific LBP.

Main Methods:

• Prospective data collection from 300 patients undergoing CT discography.
• Classification of 816 discs based on pre-discography diagnosis (disc herniation, degenerated disc, lumbar syndrome, lumbar radicular syndrome).
• Evaluation of CT discograms for pain response, disc degeneration, and annular disruption.

Main Results:

• A high percentage of patients with disc herniation (82%) and degenerated discs (80%) exhibited positive pain provocation and significant disc deterioration.
• Over half of patients with lumbar syndrome (56%) and lumbar radicular syndrome (59%) also showed positive pain provocation and moderate to severe disc deterioration.
• CT discography demonstrated a strong correlation between intradiscal pathology and reported pain in various LBP classifications.

Conclusions:

• Intradiscal pathology is a significant contributor to pain in patients diagnosed with various low-back pain syndromes.
• CT discography is a valuable tool for identifying intradiscal pathology and its association with pain in LBP.
• These findings highlight the importance of evaluating disc integrity in the management of nonspecific low-back pain.