In 1990, Antti-Poika et al. conducted a prospective study of 279 injected discs in 100 patients. Exact reproduction of pain on injection was more common in fissured or ruptured discs. The results indicated that discography had a sensitivity of 81% and specificity of 64% for pain. Additional information yielded by follow-up CT scan was minimal (44).
Also in 1990, Bernard prospectively studied 250 patients with low back pain who underwent lumbar dis cography followed by CT scan. In 93% of the patients, the combined discogram/CT provided significant information regarding equivocal or multiple level abnormalities and type of herniation, defining surgical options, and evaluating previously operated spines. In 94% of the patients, discography/CT correctly predicted disc hernia-tion as protruded, extruded, sequestrated, or internally disrupted (45).
In 1991, Simmons et al. performed a study in which 164 patients with low back pain underwent discography and MRI. Discography and MRI results correlated in 80% of the cases. Of abnormal disks, 76% reproduced symptoms on discography (46).
In 1996, Schellhas et al. conducted a retrospective study of patients until records of 100 HIZ discs in 63 patients were found. Eighty-seven of the 100 discs tested were found to be concordantly painful. All 87 showed annular tears to the outer third of the annulus fibrosus. Of the 67 non-HIZ discs studied, 64 were nonconcordant. Schellhas concluded that in patients with symptomatic lower back pain, the HIZ is a reliable marker of painful outer annular disruption (13).
Fig. 18. Cervical spine discogram morphology. (A) Anteroposterior fluoroscopic image shows contrast opacifying the nucleus pulposus with extension posterolaterally into the uncovertebral articulations (arrowsheads). Opacification of these regions in patients >20 yr old should not be confounded for degenerative disc disease based on this morphologic finding alone. (B) Second example of a three-level discogram, with contrast opacifying the uncovertebral articulation (arrowhead).
In 1998, Saifuddin et al. retrospectively reviewed 99 lumbar discogram reports in which 260 discs were injected and 179 were abnormal. They found that pain experienced in the buttock, hip, groin, or lower limb can arise from the posterior annulus without direct involvement of the nerve root (47).
Lastly, in 2000, Lam et al. conducted a prospective blinded study in which they found a significant correlation between abnormal disc morphology and the HIZ on MRI. In morphologically abnormal discs, a significant correlation between HIZ and reproduction of exact or similar pain is typical. Sensitivity, specificity, and positive predictive value for pain reproduction were 81%, 79%, and 87%, respectively (14).
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