[The FADI score--a possibility for the quantified differential diagnosis of discogenic pain].
OBJECTIVE
Chronic, non-radicular low-back pain has varying reasons. The main causes are a zygoapophysial joint syndrome, discogenic pain, especially the rupture of the inner disc, the IS joint syndrome as well as a myofascial syndrome. Especially the differentiation between zygoapophysial joint pain and discogenic pain often proves to be difficult in the clinical routine. In the literature, different criteria can be found concerning the distinction of zygoapophysial joint pain and discogenic pain. Clinical criteria, criteria of imaging as well as intensive diagnostics are described. So far there is a lack of a summarizing evaluation of these aspects.


METHODS
The FADI score uses clinical criteria with combinations of motion, consisting of rotation, side inclination, anteflexion and pressure-sensitive spots, imaging aspects and the invasive diagnostics by means of selective blockades of zygoapophysial joints and discography or rather disc stimulation. The examination results are summed up and judged as to their relevance as well as validity through our score.


RESULTS
First of all the relevance of the single aspects was judged in a primary test with 30 patients. The diagnostic block and the clinical criteria for the zygoapophysial joint syndrome as well as discography and MRI for discogenic pain had the best results. Afterwards the score was tested in the clinical area with 56 patients and showed its value under clinical conditions.


CONCLUSIONS
Especially when dealing with patients suffering from chronic back pain, the score serves to simplify the choice of a further therapy, including invasive procedures, or rather to avoid unnecessary major surgery at the spine.
DRK-Schmerzzentrum Mainz. martin.legat@drk-schmerz-zentrum.de
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Legat
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Brandmaier
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Casser
D020000:Decision Support Systems, Clinical; D003936:Diagnosis, Computer-Assisted / Q000379:methods*; D003937:Diagnosis, Differential; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000150:complications / Q000175:diagnosis*; D007592:Joint Diseases / Q000150:complications / Q000175:diagnosis; D017116:Low Back Pain / Q000150:complications / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D009209:Myofascial Pain Syndromes / Q000150:complications / Q000175:diagnosis; D010147:Pain Measurement / Q000379:methods*; D011379:Prognosis; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D021801:Zygapophyseal Joint