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European Spine Journal
Published in: European Spine Journal 10/2014

01-10-2014 | Original Article

Comparison between pain at discography and morphological disc changes at axial loaded MRI in patients with low back pain

Authors: Hanna Hebelka, Helena Brisby, Tommy Hansson

Published in: European Spine Journal | Issue 10/2014

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Abstract

Purpose

Discogenic pain is induced by axial load, but there are no studies evaluating the influence of dynamic MRI in relation to provoked pain at discography. The aim of this study was to investigate the relationship between discography-induced pain and morphological disc changes, occurring during axial loaded MRI (alMRI). A secondary aim was to compare and register the frequency of provoked concordant pain at alMRI and discography.

Methods

41 patients with assumed discogenic pain were investigated with MRI, alMRI and pressure-controlled discography (PCD) (119 discs). Provoked pain at both discography and alMRI was classified as concordant or discordant with daily pain as reference. A concordant discogram required pain intensity ≥5/10 (numerical rating scale) at ≤50 psi and one negative control disc. A concordant provocation at alMRI required pain intensity ≥5/10. The relationship between concordant pain at discography and morphological disc measures (degeneration, height, bulge, angle, area, and circumference) at MRI/alMRI was investigated.

Results

Changes in the morphological appearance occurred in at least one disc level in all patients when loaded and unloaded MRI were compared. However, no significant differences between concordant and discordant discograms in terms of morphological disc features at conventional MRI or alMRI were found. 78 % of the patients reported concordant provoked pain during the alMRI.

Conclusions

In the majority of patients with low back pain, discography as well as alMRI provoked concordant pain. Loading of the spine, alMRI, revealed however no clinically useful morphological characteristics in the discs with concordant discograms. Alternative or more sensitive diagnostic methods are needed to understand load-induced discogenic pain.
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Metadata
Title
Comparison between pain at discography and morphological disc changes at axial loaded MRI in patients with low back pain
Authors
Hanna Hebelka
Helena Brisby
Tommy Hansson
Publication date
01-10-2014
Publisher
Springer Berlin Heidelberg
Published in
European Spine Journal / Issue 10/2014
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI
https://doi.org/10.1007/s00586-014-3408-6

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