Fig 5. Patient is a 35-year-old man with long-standing lower back pain along with minor leg diskomfort, experiencing increasing pain during the past year. Outside MR imaging demonstrated significant degenerative changes at L4-5 and L5-S1, with possible spondylolysis of L5. Currently, he claimed the back pain would "bring him to his knees" (VAS score, 10/10), and diskography was requested in consideration of surgical intervention. After 3-mL contrast was injected at L5-S1, severe and concordant LBP was provoked without leg pain (VAS score, 10/10). Injection of 1-mL lidocaine resulted in complete elimination of his provoked back pain.

A, Frontal diskographic image at L5-S1 demonstrates degenerative disk changes with annular tears and fragmentation (arrow), along with a peripheral annular tear projecting over the left foraminal disk margin (arrowhead) and focal leakage into the foramen and far lateral region (short arrow).

B, Axial postdiskographic CT image demonstrates internal annular tears and fragmentation (arrow) and a peripheral annular tear on the left (short arrow), with leakage into the epidural space, L5-S1 foramen, and far lateral region (arrowheads).