Are outer annular fissures stimulated during diskography the source of diskogenic low-back pain? An analysis of analgesic diskography data.
OBJECTIVE
This study aimed to clarify whether painful annular fissures stimulated during provocation diskography are the likely source of diskogenic pain.


METHODS
A retrospective analysis was conducted of prospectively collected data.


METHODS
Multidisciplinary, academic spine center.


METHODS
The study was completed in a cohort of 28 consecutive patients were enrolled presenting with 6 months duration of axial low-back pain recalcitrant to physical therapy, oral analgesics, and epidural steroid injections and who have diskogenic pain based on history, exam, magnetic resonance imaging, and diskography.


METHODS
Subjects underwent provocation diskography and analgesic diskography utilizing a balloon-tipped intradiskal catheter allowing intradiskal injection of anesthetic.


METHODS
Visual analog scale, finger-to-floor distance were utilized as outcome measures.


RESULTS
80% of painful intervertebral disks as detected by provocation diskography were sufficiently anesthetized resulting in >50% reduction in low-back pain during analgesic diskography.


CONCLUSIONS
Diskogenic pain is in varying degrees caused by the sensitized nociocepters within annular tears.
DePalma
Michael J
MJ
Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University/Medical College of Virginia Hospitals, Richmond, VA 23235, USA. depalmamj8@yahoo.com
Lee
Jeong-Eun
JE
Peterson
Lane
L
Wolfer
Lee
L
Ketchum
Jessica M
JM
Ketcum
Jessica
J
Derby
Richard
R
D000328:Adult; D000777:Anesthetics / Q000008:administration & dosage; D003287:Contrast Media / Q000008:administration & dosage; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D007278:Injections, Spinal; D007403:Intervertebral Disc / Q000000981:diagnostic imaging / Q000294:innervation / Q000473:pathology*; D008012:Lidocaine / Q000008:administration & dosage; D017116:Low Back Pain / Q000188:drug therapy* / Q000209:etiology*; D008297:Male; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed
D000777:Anesthetics; D003287:Contrast Media; D008012:Lidocaine