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The Prevalence and Clinical Features of Internal Disc Disruption in Patients With Chronic Low Back Pain

Schwarzer, Anthony C., MB, BS, PLD, FRACP*; Aprill, Charles N., MD; Derby, Richard, DO; Fortin, Joseph, DO§; Kine, Garrett, MD; Bogduk, Nikolai, MD, PLD*

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Study Design This was a cross-sectional analytic study of patients with chronic low back pain.

Objective To investigate whether the criteria for internal disc disruption, as adopted by the International Association for the Study of Pain, could be satisfied in patients with chronic low back pain and to test whether there were any conventional clinical features that could identify this condition.

Summary of Background Data Internal disc disruption has been postulated as an important cause of low back pain. To diagnose this condition, the International Association for the Study of Pain taxonomy requires that pain be reproduced on provocation discography and that computed tomography discography reveal internal disc disruption, provided that as a control, stimulation of at least one other disc fails to reproduce pain.

Methods Ninety-two consecutive patients with chronic low back pain and no history of previous lumbar surgery were studied. Each patient underwent a standard physical examination. Computed tomography discography was performed at a minimum of two levels.

Results The diagnostic criteria for internal disc disruption were fully satisfied in 39% of patients, most commonly at L5-S1 and L4-L5. None of the clinical tests used could differentiate between those patients with internal disc disruption and other patients.

Conclusions A diagnosis of internal disc disruption can be made in a significant proportion of patients with chronic low back pain, but no conventional clinical test can discriminate patients with internal disc disruption from patients with other conditions.

*Faculty of Medicine, The University of Newcastle, Newcastle, Australia, New Orleans.

Magnolia Diagnostics Inc., New Orleans, Louisiana, New Orleans.

Spinecare, Daly City, California, and §Diagnostic Conservative Management, New Orleans.

© Lippincott-Raven Publishers.