The role of discography in lumbar disc disease: A comparative study of magnetic resonance imaging and discography

Collins, Christopher G.; Stack, John D.; O'Connell, D. J.; Walsh, M. G.; McManus, F.; Redmond, O.; Ennis, J. T.

doi:10.1016/s0009-9260(05)82113-0

Cited by 65 publications

(27 citation statements)

References 30 publications

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“…It is a subjective test relying on the radiologists' and patients' perceptions to determine the result. [29][30][31][32][33][34][35][36] Many patients with such complaints have associated psychological or psychiatric disturbances which may or may not be associated with medicolegal factors. All of these decrease their ability to give an accurate opinion as to whether the pain produced at discography is that of which they are complaining.…”

Section: Discussionmentioning

confidence: 99%

Intervertebral discs which cause low back pain secrete high levels of proinflammatory mediators

Burke

Watson

McCormack

et al. 2002

The Journal of Bone and Joint Surgery. British volume

330

248

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H erniated intervertebral disc tissue has been shownto produce a number of proinflammatory mediators and cytokines, but there have been no similar studies using discs from patients with discogenic low back pain.We have compared the levels of production of interleukin-6 (IL-6), interleukin-8 (IL-8) and prostaglandin E 2 (PGE 2 ) in disc tissue from patients undergoing discectomy for sciatica (63) with that from patients undergoing fusion for discogenic low back pain (20) using an enzyme-linked immunoabsorbent assay.There was a statistically significant difference between levels of production of IL-6 and IL-8 in the sciatica and low back pain groups (p < 0.006 and p < 0.003, respectively).The high levels of proinflammatory mediator found in disc tissue from patients undergoing fusion suggest that production of proinflammatory mediators within the nucleus pulposus may be a major factor in the genesis of a painful lumbar disc. [Br] 2002;84-B:196-201. J Bone Joint Surg Received 8 June 2001; Accepted 3 August 2001The pathophysiology of discogenic low back pain is incompletely understood. 1 The changes which occur as a disc degenerates are well documented, but are unhelpful in determining whether a degenerate disc will cause pain.2 It is known that disc tissue from patients undergoing discectomy for sciatica synthesises proinflammatory mediators and cytokines. 3-12 Sequestrated and extruded discs produce higher levels of these mediators than specimens in which the annulus is intact. 5,10,12,13 To date, there have been no studies of the production of inflammatory mediators in disc tissue from patients undergoing operations for discogenic low back pain. It has been shown, however, that degenerate discs in these patients contain more nociceptive nerve endings in the endplates of the disc and in the nucleus pulposus than do degenerate discs which do not cause low back pain. 14, 15 We have therefore compared levels of production of the proinflammatory mediators tumour necrosis factor alpha (TNF␣), interleukin-1beta (IL-1␤), interleukin-6 (IL-6), interleukin-8 (IL-8) and prostaglandin E 2 (PGE 2 ), in disc tissue from patients undergoing discectomy for sciatica with those from patients undergoing fusion for discogenic low back pain. Patients and MethodsWe obtained specimens of intervertebral disc from 63 patients undergoing primary lumbar discectomy for sciatica. Intraoperative assessment of the morphology of the disc herniation revealed 25 in which the annulus was intact (AI), 30 in which a nuclear extrusion was present (EXT) and eight in which the nucleus was sequestrated (SEQ). The mean ages were 42 years in the AI group, 39.5 years in the EXT group and 42 years in the SEQ group. The male: female ratio in the AI, EXT and SEQ groups was 17:8, 20:10 and 6:2, respectively. Three specimens were from the L3/L4 level, 28 from the L4/L5 level and 32 from the L5/ S1 level.We also obtained disc specimens from 20 patients undergoing primary lumbar interbody fusion for discogenic low back pain, which had been confirmed by discograph...

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Section: Discussionmentioning

confidence: 99%

Intervertebral discs which cause low back pain secrete high levels of proinflammatory mediators

Burke

Watson

McCormack

et al. 2002

The Journal of Bone and Joint Surgery. British volume

330

248

View full text Add to dashboard Cite

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“…Collins et al [5] attempted to correlate Modic changes with symptomatic discs at discography, identifying such changes in 6 of 13 patients with positive discograms. Modic changes were also present adjacent to asymptomatic discs.…”

Section: Discussionmentioning

confidence: 99%

“…bility therefore arises that Modic changes are in some cases the result of chemical inflammation from degenerative discs and may be a secondary sign on MRI of "internal disc disruption" and discogenic low back pain. Previous studies have tried to correlate disc degeneration and the high-intensity zone (HIZ) on MRI with pain reproduction at lumbar discography, with variable results [1,5,11,16,17,[19][20][21][22]. The aim of the present study was to correlate the presence of Modic changes with pain reproduction at lumbar discography, in a group of patients with a clinical diagnosis of discogenic low back pain.…”

Section: Introductionmentioning

confidence: 99%

Vertebral end-plate (Modic) changes on lumbar spine MRI: correlation with pain reproduction at lumbar discography

Braithwaite

White

Saifuddin

et al. 1998

European Spine Journal

303

200

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IntroductionVertebral end-plate (Modic) changes were first described independently by de Roos et al. [9] and Modic et al. [15] as being a feature associated with degenerative intervertebral disc disease. Type I changes consist of reduced signal intensity (SI) in the vertebral end-plates on T1-and increased SI on T2-weighted sequences (Fig. 1). They are associated with fissuring of the cartilaginous end-plate and increased vascularity within the subchondral bone marrow on histological examination. Type II changes consist of increased SI on T1-and either increased SI or isointensity on T2-weighted sequences (Fig. 2). In such cases, biopsy reveals fatty replacement of the marrow [15], which is thought to be the result of marrow ischaemia [9]. Type III changes consist of reduced SI on both T1-and T2-weighted sequences due to subchondral sclerosis ( Fig. 3). Type I changes commonly progress to Type II changes and rarely revert back to normal, whereas Type II changes appear not to change with time [15]. Modic changes are identified in 20-50% of patients, with the incidence increasing with age [9,15]. However, it is not known why some degenerative discs are associated with Modic changes while others are not.Crock [6,7] proposed the concept of "internal disc disruption", suggesting that repeated trauma to the intervertebral disc could result in the production of inflammatory substances within the nucleus pulposus. Diffusion of such toxic chemicals through the vertebral end-plate could then result in a local inflammatory reaction resulting in back pain.Inflammation in the subchondral bone adjacent to the end-plate would result in reduced SI on T1-weighted MRI sequences and increased SI on T2-weighted MRI sequences, equivalent to a Type 1 Modic change. The possiAbstract The vertebral end-plate has been identified as a possible source of discogenic low back pain. MRI demonstrates end-plate (Modic) changes in 20-50% of patients with low back pain. The aim of this study was to investigate the association between Modic changes on MRI and discogenic back pain on lumbar discography. The MRI studies and discograms of 58 patients with a clinical diagnosis of discogenic back pain were reviewed and the presence of a Modic change was correlated with pain reproduction at 152 disc levels. Twenty-three discs with adjacent Modic changes were injected, 21 of which were associated with pain reproduction. However, pain was also reproduced at 69 levels where no Modic change was seen. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for a Modic change as a marker of a painful disc were 23.3%, 96.8%, 91.3% and 46.5% respectively. Modic changes, therefore, appear to be a relatively specific but insensitive sign of a painful lumbar disc in patients with discogenic low back pain.

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“…Because of a lack of a definitive association between morphological changes in MRI and clinical symptoms of discopathy [4,21], discography continues to play a role for patients with inconclusive clinical and image findings for presurgical evaluation or before minimally invasive treatment [5,6]. Discography is usually performed under fluoroscopy and/or CT guidance.…”

Section: Discussionmentioning

confidence: 99%

MR-guided discography using an open 1 Tesla MRI system

et al. 2010

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The role of discography in lumbar disc disease: A comparative study of magnetic resonance imaging and discography

Cited by 65 publications

References 30 publications

Intervertebral discs which cause low back pain secrete high levels of proinflammatory mediators

Intervertebral discs which cause low back pain secrete high levels of proinflammatory mediators

Vertebral end-plate (Modic) changes on lumbar spine MRI: correlation with pain reproduction at lumbar discography

MR-guided discography using an open 1 Tesla MRI system

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