Fig 2. Patient is a 36-year-old man with long-standing back pain and left leg pain (VAS score, 8/10), who had prior diskectomy at L4-5, with only limited improvement. Diskography was requested for follow-up assessment. After 2-mL contrast injection at L5-S1, severe nonconcordant pain was provoked (VAS score, 8/10) with no improvement after 1 mL of intradiskal lidocaine administration. His pain did reproduce concordantly at the diskectomy level.

A, Outside MR sagittal T2-weighted image demonstrates significant degenerative disk changes at L4-5 and L5-S1 (arrowheads) with a high-intensity zone noted along the posterior L5-S1 disk margin (arrow).

B, Lateral diskographic fluoroscopic image obtained after contrast injection at L5-S1 demonstrates degenerative changes (arrow), without evidence of contrast leakage. Contrast dilution was noted throughout the disk after lidocaine administration (not shown), but provoked pain did not improve.

C, Axial postdiskographic CT image obtained at L5-S1 demonstrates a contained radial tear with focal disk protrusion and focal contrast accumulation without epidural leakage (arrow).