Predictive signs of discogenic lumbar pain on magnetic resonance imaging with discography correlation.

STUDY DESIGN: The correlation between discogenic lumbar pain and disc morphology was investigated by using magnetic resonance imaging and discography.

OBJECTIVES: To assess the various pathologic parameters seen on magnetic resonance imaging in patients with discogenic lumbar pain and to correlate them with observations on discography.

SUMMARY OF BACKGROUND DATA: Although numerous previous studies on the subject have been performed, the correlations between various pathologic findings on magnetic resonance imaging and pain reproduction by provoked discography have not been explained fully.

METHODS: One hundred and one lumbar discs in 39 patients were studied with magnetic resonance imaging and pain provocation discography. When pain reproduction under discography was concordant, various pathologic parameters on magnetic resonance imaging were analyzed by three statistical parameters to determine the associated magnetic resonance imaging findings.

RESULTS: Radial tears commonly are demonstrated on magnetic resonance imaging in discs with concordant pain on discography. The presence of these tears is not a reliable predictor of a painful disc on discography. Although a high-intensity zone on T2-weighted images is a relatively reliable predictor of pain, the statistical values were lower than those in previous studies. Massive degeneration and severe disc height loss were rare in this population. These findings were good predictors of pain on disc injection.

CONCLUSIONS: Although the lumbar intervertebral discs with posterior combined anular tears are likely to produce pain, the validity of these signs for predicting discogenic lumbar pain is limited.