Fig 4. Patient is a 40-year-old man with long-standing severe lower back pain (VAS score, 10/10) and some leg diskomfort, without specific injury or trauma, with an outside MR imaging study that demonstrated degenerative disk changes at L4-5 and L5-S1. He was being considered for surgical intervention, and diskography was requested. After 3-mL contrast injection at L4-5, the patient developed severe and concordant pain (VAS score, 10/10). Injection of 1.5-mL lidocaine into this painful disk resulted in complete or near-complete elimination of the provoked pain.

A, Lateral diskographic fluoroscopic image at L4-5 demonstrates degenerative disk changes (arrow) with clear contrast leakage extending into the epidural space (arrowheads).

B, Axial postdiskographic CT image at L4-5 demonstrates complex degenerative changes with both nuclear fragmentation and annular tears (arrow) and a small disk protrusion and focal leakage of contrast into the adjacent epidural space on the left (arrowhead).