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To investigate the correlation among age, disc morphology, positive discography, and prognosis in patients with chronic low back pain.
A total of 183 intervertebral discs in 72 patients with chronic low back pain were studied. Discography was performed using a pressure-controlled manometric technique. The pain reaction during discography at each level was recorded as follows: no pain, dissimilar pain, similar pain, or concordant pain. Discs with similar or concordant pain were classified as positive. All the examined discs were assessed morphologically using axial computed tomography imaging. The grade of general degeneration and annular disruption of the discs were assessed according to the Dallas discogram description (DDD). Intradiscal injection of steroid was tried for patients with symptomatic disc identified during provocative discography and who did not consent to surgical operation.
There was a higher correlation between general degeneration and age, as compared with annular disruption and age. Higher general degeneration and annular disruption grades had higher positive rates of discography. However, annular disruption alone was independently associated with positive discography. Age and grade of general degeneration did not affect the prognosis.
The grade of general degeneration was associated with age, but it was not correlated with positive discography and prognosis. In addition, high grade of annular disruption correlated with positive discography.
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Method: Seventy-one patients with lumbar discogenic pain and total 109 discography were studied. During contrast mediun injection, the patient's pain response was reported. The patients were invited to choose among the following options: 'no pain or only pressure feeling', 'dissimilar', 'similar', and 'exact'. And pain location was chosen among the followings: 'low back', 'buttock', 'anterior thigh', 'posterior thigh', and 'lateral thigh'. Correlation between degeneration and provocation response was analyzed. And discography level and provocation area were evaluated.
Results: Low back and buttock area was the most common provocation pain site, but it was not specific by disc level. And provocation pain frequently appeared in irregular and fissured types, but the existence of provocation pain was significantly low in ruptured type.
Conclusion: There was no correlation between provocation pain area and discography level. And existence rate of provocation pain in ruptured disc was very low. It might be due to low mechanical compression with little stimulation of nociceptor. We suggested that if patients have a ruptured disc with chemical irritation, provocation pain was not a good indicator of diagnosis of discogenic back pain.
Objective: To determine the changes of posterior bulging of the lumbar intervertebral discs with flexion and extension movement of the spine in patients with central disc bulges or disc degeneration.
Method: Twenty patients with low back pain were studied. Nine patients had central type disc bulging and eleven patients had disc degeneration only. The spines were scanned in neutral, flexion, and extension positions in a vertically open 0.5T MR scanner. Degree of posterior bulging of the lumbar intervertebral disc of the pathological level was measured.
Results: In the patients with disc bulge, posterior bulging of the disc decreased in all of the patients by 0.8⁑0.6 mm with flexion of the spine and increased in 77.8% of the patients by 1.0⁑0.8 mm with extension of the spine. In the patients with disc degeneration, posterior bulging decreased with flexion in 36.7% of the patients. With extension, posterior bulging increased in 55.6% of the patients.
Conclusion: This study found that patients with low back pain and central disc bulges have consistent and marked discrepancies in posterior bulging with flexion-extension in comparison with our previous study with asymptomatic patients with normal MRIs.
Objective: To examine the correlation between bone mineral density and intervertebral disc degeneration through retrospective study.
Method: Bone mineral density (BMD) and Magnetic resonance (MR) image of lumbar spine from 61 postmenopausal women were assessed to examine the correlation between bone mineral density and intervertebral disc degeneration. We determined BMD of lumbar spine using the dual energy X-ray absorptiometry (DEXA). And we evaluated signal intensity of intervertebral disc, disc height and disc herniation at each lumbar disc level using the MR image. The correlation between BMD (mean value of 2nd, 3rd and 4th lumbar spine BMD) and the sum of grading scores of intervertebral disc degeneration was assessed in all the patients.
Results: There was a positive correlation between BMD of lumbar spine and the sum of grading scores of intervertebral disc degeneration (r=0.415, p value=0.00087).
Conclusion: Bone mineral density has an inverse correlation to intervertebral disc degeneration and which is important when considering degenerative spinal disease and osteoporosis.
Objective: To determine the relationship between magnetic resonance imaging (MRI) and discography in visualization of disc degeneration.
Method: Forty-eight patients with suspected discogenic pain in lumbar spines and degenerative changes of the lumbar intervertebral discs in T2-weighted magnetic resonance imaging were studied. Five types of discogram (cottonball, lobular, irregular, fissured, and ruptured) were classified by identifiable features in shape and density of radio-opaque shadow. Three types of MRI (bulging, protrusion, and extrusion) were classified by degrees of disc herniation. The correlation between two imaging techniques of lumbar intervertebral discs were analyzed using Spearman's correlation coefficient.
Results: Of sixty-three discs, MRI finding of the disc herniation revealed as follows: bulging, 17 discs; protrusion, 20 discs; extrusion, 26 discs. Discography revealed as follows: cottonball, 15 discs; lobular, 2 discs; irregular, 11 discs; fissured, 10 discs; ruptured, 25 discs. 46 discs of 63 discs showed internal structural abnormalities (irregular, fissured, or ruptured). There was no statistically significant correlation between MRI and discography in visualization of the disc degeneration (r=0.081).
Conclusion: Severity of the lumbar intervertebral disc degeneration in MRI was not correlated with degenerative severity of discographic imaging. Supplementary discography may be useful in evaluation of patients with discogenic pain since discographic imaging when compared to MRI visualizes disc degeneration more accurately.
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