Ann Rehabil Med.  2015 Jun;39(3):340-346. 10.5535/arm.2015.39.3.340.

Analysis of the Correlation Among Age, Disc Morphology, Positive Discography and Prognosis in Patients With Chronic Low Back Pain

• Kim SM
• Lee SH
• Lee BR
• Hwang JW

• KMID: 2165636
• DOI: http://doi.org/10.5535/arm.2015.39.3.340

Abstract

OBJECTIVE
To investigate the correlation among age, disc morphology, positive discography, and prognosis in patients with chronic low back pain.
METHODS
A total of 183 intervertebral discs in 72 patients with chronic low back pain were studied. Discography was performed using a pressure-controlled manometric technique. The pain reaction during discography at each level was recorded as follows: no pain, dissimilar pain, similar pain, or concordant pain. Discs with similar or concordant pain were classified as positive. All the examined discs were assessed morphologically using axial computed tomography imaging. The grade of general degeneration and annular disruption of the discs were assessed according to the Dallas discogram description (DDD). Intradiscal injection of steroid was tried for patients with symptomatic disc identified during provocative discography and who did not consent to surgical operation.
RESULTS
There was a higher correlation between general degeneration and age, as compared with annular disruption and age. Higher general degeneration and annular disruption grades had higher positive rates of discography. However, annular disruption alone was independently associated with positive discography. Age and grade of general degeneration did not affect the prognosis.
CONCLUSION
The grade of general degeneration was associated with age, but it was not correlated with positive discography and prognosis. In addition, high grade of annular disruption correlated with positive discography.

Keyword

Low back pain; Intervertebral disc degeneration; Radiography; Computed tomography

MeSH Terms

Humans
Intervertebral Disc
Intervertebral Disc Degeneration
Low Back Pain*
Prognosis*
Radiography

Figure

• 

  Fig. 1 General degeneration of Dallas discogram description. (A) Grade 0, no change. (B) Grade 1, local (<10%). (C) Grade 2, partial (<50%). (D) Grade 3, total (>50%).

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  Fig. 2 Annular disruption of Dallas discogram description. (A) Grade 0, none. (B) Grade 1, into inner annulus. (C) Grade 2, into outer annulus. (D) Grade 3, beyond outer annulus.

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  Fig. 3 Distribution of age, examined level and positive discography.

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  Fig. 4 Grade of general degeneration and rates of positive discography (linear by linear association=21.530, p<0.001). Positive discography is classified discs with similar or concordant pain. Grade 0, no change; grade 1, local (<10%); grade 2, partial (<50%); grade 3, total (>50%).

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  Fig. 5 Grade of annular disruption and rates of positive discography (linear by linear association=34.425, p<0.001). Positive discography is classified discs with similar or concordant pain. Grade 0, none; grade 1, into inner annulus; grade 2, into outer annulus; grade 3, beyond outer annulus.

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