Fig 1. Patient is a 39-year-old man with an injury 20 years ago related to an overturned military vehicle. He has long-standing lower back pain that has recently worsened (VAS score, 8/10). Significant degenerative disk changes are present at L4-5 and L5-S1 on MR imaging, and surgery is now being considered. After 3-mL contrast injection at L5-S1, severe concordant lower back pain was provoked (VAS score, 8/10), with no improvement after 1 mL of intradiskal lidocaine administration.

A, Frontal diskographic fluoroscopic image obtained after contrast injection at L5-S1 demonstrates degenerative changes with nuclear and annular fragmentation (arrow) but no contrast leakage.

B. Axial postdiskographic CT image obtained at L5-S1 demonstrates significant degenerative disk changes with central and peripheral annular tears (arrows) without leakage.