Clinical Research Article

Korean J Pain 2021; 34(4): 447-453

Published online October 1, 2021 https://doi.org/10.3344/kjp.2021.34.4.447

Copyright © The Korean Pain Society.

Predictors of discogenic pain in magnetic resonance imaging: a retrospective study of provocative discography performed by posterolateral approach

Anuj Jain1 , Suruchi Jain2 , Swapnil Kumar Barasker3 , Amit Agrawal4

1Department of Anesthesiology, All India Institute of Medical Sciences, Bhopal, India
2Department of Nuclear Medicine, All India Institute of Medical Sciences, Bhopal, India
3Department of Anesthesiology, Sri Aurobindo Medical College and Post Graduate Institute, Indore, India
4Department of Neurosurgery, All India Institute of Medical Sciences, Bhopal, India

Correspondence to:Swapnil Kumar Barasker
Department of Anesthesiology, Sri Aurobindo Medical College and Post Graduate Institute, Indore Ujjain State Highway, Near MR10 Crossing, Indore 453111, India
Tel: +91-8109101245
Fax: +91-731-4231010
E-mail: swapnilkbarasker@gmail.com

Handling Editor: Francis S. Nahm

Received: May 3, 2021; Revised: July 1, 2021; Accepted: July 5, 2021

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.


Background: Provocative discography (PD) is a test that is useful in diagnosing discogenic pain (DP). In this study, to diagnose DP, we used a posterolateral approach of needle placement and followed pressure criteria laid down by the Spine Intervention Society. The aim was to identify the correlation between magnetic resonance imaging (MRI) findings (desiccation, high intensity zone and change in shape and size of the disc) and the results of PD.
Methods: Records of 50 patients who underwent PD for DP were analyzed. A total of 109 PDs were performed, with 54 suspect and 55 control discs. Alternate pain generators were ruled out.
Results: A total of 35 suspect discs were positive on PD. The mean disc pressure in the suspect disc was 31.9 ± 7.9 psi (range, 15-44). Of the 50 patients who underwent PD, 35 had positive MRI findings. A significant positive correlation was found only between disc desiccation and discography result (r = 0.6, P < 0.001). Logistic regression analysis revealed that only desiccation successfully predicted the result of discography (OR = 26.5, P < 0.001); a high intensity zone and a disc protrusion/extrusion had an OR 2.3 and 1.24, respectively. Disc desiccation of Pfirmann grade 3 or more had a sensitivity and specificity of 0.93 and 0.64 respectively in identifying painful discs; the positive likelihood ratio was 2.58 while the negative likelihood ratio was 0.11.
Conclusions: In patients with DP, disc desiccation is the most useful MRI feature that predicts a painful disc on PD.

Keywords: Desiccation, Diagnosis, Discography, Intervertebral Disc, Intervertebral Disc Degeneration, Low Back Pain, Magnetic Resonance Imaging, Pain Management, Sensitivity and Specificity, Spinal Diseases.