INTRODUCTION: Lumbar intervertebral discs are common sources of low back pain (LBP) due to annular fissures. Provocation lumbar discography (PLD) has been used to diagnose painful discs. Analgesic discography (AD) has been explored to more accurately diagnose LBP by anesthetizing all grades of annular fissures. This study evaluates which grade of annular tear (III‐V) is more frequently associated with LBP reduction during AD.
METHODS: Retrospective review of patients with positive PLD at low pressure at 1 or 2 levels and > grade 3 annular tear on post‐discography CT. Reproduction of LBP upon injection of 2% xylocaine and pressure upon injection of saline into the painful disc(s) during AD. Subjects demonstrating painful schmorl's node; concordant/partial concordant pain without outer annular disruption; > 2 painful discs during PLD were excluded. Chi‐square analysis was performed to detect differences in proportions of subjects having reduction in LBP during AD.
RESULTS: 35 discs (17 L5‐S1, 17 L4‐L5, and 1 L1‐L2) underwent PLD & AD in 28 patients (16 males; 57%) with a mean age of 40.4 years (SD = 8.7). Using > 75% reduction in LBP during AD as the reference standard, we observed 33%, 31%, and 54% of grade III, IV, and V fissures, respectively, showing at least 75% reduction in pain. These percentages were compared and not found to be significantly different (χ2 = 1.7, df = 2, p‐value = 0.4346). No difference was observed between grades III and IV after being grouped together (31.8%) and grade V (53.9%) tears (p‐value = 0.1987).
CONCLUSIONS: These findings do not suggest that the grade of annular tear is significantly related to the ability of intradiscal anesthetic to reduce LBP during AD by 75%. Furthermore, these findings may suggest that full‐thickness annular tears can be adequately anesthetized similar to grade III and IV annular tears.