Imaging Study Of Discography In Discogenic Lumbar Pain

Objective:Lumbar discogenic pain is a common clinical disease,which severely affects the quality of patient's life.To discuss clinical applied value of CT-guided discography and its guiding significance on the clinical treatment by means of the performance of MRI and CT-guided discography of the discogenic pain patients,correlation analysis between MRI and the consistent pain induced by discography.Materials and Methods:Lumbar MRI and 195 lumbar discography of 70 cases of patients with chronic low back pain were analysed.According to the degree of disc degeneration on MRI,the discs were divided into the lesion group(115 discs) and the control group(80 discs). Estimated the degree of disc degeneration and rupture of anulus fibrosus on discography,according to Dallas Discogram Description(DDD).Vertebral endplate degeneration was judged on the basis of Modic classification standard.Induced-pain were classified into consistent induced-pain,non-consistent induced-pain and painless. Correlation analysis among the classification of discography,disc degeneration on MRI and the consistent induced-pain was studied.Through the use of SPSS11.0 statistical package,lumbar discogenic pain on high incidence of age,good site,the morphological changes of intervertebral disc, and correlation analysis between the classification of vertebral endplate osteochondritis and the consistent pain induced by discography were studied.Results:195 discs of 70 cases were made by means of CT-guided discography,which included 62 discs with consistent induced-pain,44 discs with non-consistent induced-pain and 89 discs with painless.According to the classification of DDD,108 discs among 195 appeared 1 to 3 degree disc degeneration,a significant correlation between disc degeneration and consistent induced-pain existed(X²=73.227, r=0.5225,P＜0.01);93 discs among 195 appeared 1 to 3 degree rupture of corresponding anulus fibrosus,a significant correlation between rupture of anulus fibrosus and consistent induced-pain existed(X²=99.699,r=0.5816,P＜0.01).62 positive discs on discography were classified according to DDD:16 discs with 1 degree disc degeneration(25.81%),21 discs with 2 degree disc degeneration (33.87%),25 discs with 3 degree disc degeneration(40.32%);19 discs with 1 degree rupture of anulus fibrosus(30.64%),40 discs with 2 degree rupture of anulus fibrosus(64.52%),3 discs with 3 degree rupture of anulus fibrosus(4.84%)There was a correlation between abnormity of disc signal and shape on MRI and the consistent pain induced by discography(X²=63.24,r=0.4949,P＜0.05). There was a correlation between HIZ and consistent induced-pain(X²=76.5476, r=0.5309,P＜0.05).61 discs among 195 appeared vertebral endplate osteochondritis on MRI,a correlation between vertebral end-plate osteochondritis and consistent induced-pain existed(X²=17.4791,r=0.2868,P＜0.05).Vertebral end-plate osteochondritis on MRI(positive group on discography) included 21 discs withâ… type (65.63%),8 discs withâ…¡type(25.00%),3 discs withâ…¢type(9.37%).Positive rates of discography among various Modic types were statistically significant differences(X²=20.8463,P＜0.01).Conclusion:1.Lumbar discogenic pain is more common in young and middle-aged,disc degeneration is not the main pathological foundation of discogenic pain. Abnormity of disc morphology is the important reason for consistent pain induced by discography.2.It is an important basis for diagnosing discogenic pain that discography shows rupture of the disc annulus fibrosus accompanied by consistent induced-pain. 3.Discogenic pain is produced by the combined effect of mechanical and chemical factors.Many factors affect diffusion of contrast agent within the discs.4.Vertebral end-plate osteochondritis is one of the important reasons for low back pain.Especially when MRI showed disc degeneration and Modicâ… -type of endplate osteochondritis,the disc should be highly suspected as the duty disc which induced-pain.High signal zone(HIZ)on MRI sagittal T₂WI within the posterior annulus fibrosus may be considered as a higher specificity for the diagnosis of discogenic pain.5.For multiple segments of lumbar disc degeneration,CT discography can define the disc needed for surgical treatment of disc fusion,which may be cause low back pain.