title: Side of symptomatic annular tear and site of low back pain: is there a correlation?
abstract: METHODS
  A retrospective chart review.
  
  
  OBJECTIVE
  To report the correlation between the side of a concordantly painful, post-discography computer tomography (CT) visualized, annular tear, and the side of a patients' low back pain.
  
  
  BACKGROUND
  An annular fissure extending from the nucleus to the outer one-third of the annulus is thought to be the nociceptive source stimulated during provocative lumbar discography. To our knowledge, there are no studies that have attempted to delineate whether the side of the annular tear correlates with the side of the patient pain.
  
  
  METHODS
  One hundred and one post-discography CT scans, performed on patients with single level, concordantly painful, and fissured discs identified during lumbar discography, were randomly obtained from the archived and current files of the Penn Spine Center's film library. These were reviewed by both the lead author and a spine radiologist, both of who were blinded to the side of the patients pain, to determine which scans demonstrated clearly definable tears extending to the outer one-third of the annulus. Statistical analysis via the exact method was used to determine the correlation between the side of the patients tear and the side of the patients pain.
  
  
  RESULTS
  Forty post-discography CT scans met the inclusion criteria. There was a random correlation between the side of the patients concordantly painful annular tear and the side of the patients pain.
  
  
  CONCLUSIONS
  The results of this study raise several questions regarding the embryologic development of the intervertebral disc and its somite, neurologic transmission of discogenic pain, distribution of chemical inflammagens, validity of discography, technique of ESI, and technique and validity of IDET.
authors.affiliation: Department of Orthopaedic Disorders, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA.
authors.forename: C W
authors.initials: CW
authors.lastname: Slipman
authors.forename: R K
authors.initials: RK
authors.lastname: Patel
authors.forename: L
authors.initials: L
authors.lastname: Zhang
authors.forename: E
authors.initials: E
authors.lastname: Vresilovic
authors.forename: D
authors.initials: D
authors.lastname: Lenrow
authors.forename: C
authors.initials: C
authors.lastname: Shin
authors.forename: R
authors.initials: R
authors.lastname: Herzog
mesh_terms: D006801:Humans; D007403:Intervertebral Disc / Q000293:injuries*; D017116:Low Back Pain / Q000000981:diagnostic imaging* / Q000209:etiology*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed