Can magnetic resonance imaging accurately predict concordant pain provocation during provocative disc injection?

Chang Ho Kang, Yun Hwan Kim, Sang Heon Lee, Richard Derby, Jung Hyuk Kim, Kyoo Byung Chung, Deuk Jae Sung

Research output: Contribution to journalArticle

42 Citations (Scopus)

Abstract

Objective: To correlate magnetic resonance (MR) image findings with pain response by provocation discography in patients with discogenic low back pain, with an emphasis on the combination analysis of a high intensity zone (HIZ) and disc contour abnormalities. Materials and methods: Sixty-two patients (aged 17-68 years) with axial low back pain that was likely to be disc related underwent lumbar discography (178 discs tested). The MR images were evaluated for disc degeneration, disc contour abnormalities, HIZ, and endplate abnormalities. Based on the combination of an HIZ and disc contour abnormalities, four classes were determined: (1) normal or bulging disc without HIZ; (2) normal or bulging disc with HIZ; (3) disc protrusion without HIZ; (4) disc protrusion with HIZ. These MR image findings and a new combined MR classification were analyzed in the base of concordant pain determined by discography. Results: Disc protrusion with HIZ [sensitivity 45.5%; specificity 97.8%; positive predictive value (PPV), 87.0%] correlated significantly with concordant pain provocation (P∈<∈0.01). A normal or bulging disc with HIZ was not associated with reproduction of pain. Disc degeneration (sensitivity 95.4%; specificity 38.8%; PPV 33.9%), disc protrusion (sensitivity 68.2%; specificity 80.6%; PPV 53.6%), and HIZ (sensitivity 56.8%; specificity 83.6%; PPV 53.2%) were not helpful in the identification of a disc with concordant pain. Conclusion: The proposed MR classification is useful to predict a disc with concordant pain. Disc protrusion with HIZ on MR imaging predicted positive discography in patients with discogenic low back pain.

Original languageEnglish
Pages (from-to)877-885
Number of pages9
JournalSkeletal Radiology
Volume38
Issue number9
DOIs
Publication statusPublished - 2009 Sep 1

Keywords

  • Discogenic low back pain
  • Discography
  • High intensity zone
  • Lumbar intervertebral disc
  • Magnetic resonance imaging

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

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