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AJNR - American Journal of Neuroradiology

Published ahead of print on July 3, 2008
doi: 10.3174/ajnr.A1151

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American Journal of Neuroradiology 29:1455-1460, September 2008
© 2008 American Society of Neuroradiology

SPINE

Postdiskogram CT Features of Lidocaine-Sensitive and Lidocaine-Insensitive Severely Painful Disks at Provocation Lumbar Diskography

W.S. Bartynski^a, W.E. Rothfus^a and M. Kurs-Lasky^b

^a Department of Radiology, Division of Neuroradiology, Presbyterian University Hospital, University of Pittsburgh Medical Center, Pittsburgh, Pa
^b Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh Pa

Please address correspondence to Walter S. Bartynski, Division of Neuroradiology, Department of Radiology, Presbyterian University Hospital, University of Pittsburgh Medical Center, 200 Lothrop St, D132, Pittsburgh, PA 15213; e-mail: bartynskiws{at}upmc.edu

BACKGROUND AND PURPOSE: At lumbar diskography, intradiskal lidocaine can eliminate or reduce provoked diskogenic pain. The purpose of this study was to evaluate the postdiskogram CT features of lidocaine-sensitive and lidocaine-insensitive severely painful disks.

MATERIALS AND METHODS: Intradiskal lidocaine was injected at 182 severely painful levels in 111 patients. Clinical records/imaging studies were reviewed for response to intradiskal lidocaine (complete/substantial, partial, and no pain improvement), evidence of diskographic contrast leakage (fluoroscopic/CT images), and the overall postdiskogram CT appearance in these severely painful disks. The assessed traditional Dallas grade (degeneration/radial tear [RT]) was supplemented by identified postdiskogram CT features of annular derangement (annular gap [AG], RT into peripheral annular tear [PAT], isolated PAT, lamellar annular tear, free/attached annular fragments, bucket-handle tear, and peripheral annular pocket).

RESULTS: Isolated degenerative changes (40%) and radial defects with or without degeneration (60%) subsets were noted. Dallas grade 3 degeneration was most commonly observed (69%) with increased features of annular derangement in disks with a worsening Dallas grade. Complete/substantial versus no pain improvement was significantly associated with disk state (diskographic leakage, contained), radial defect (none, RT, or AG), and "RT-into-PAT" and were statistically significant in univariate models (P < .001). The associations remained significant in multivariate models. Higher Dallas degenerative grade and presence of free annular fragments were associated with a greater chance of no pain relief.

CONCLUSION: Severely painful disks demonstrated complex annular derangement with both radial defects (RTs and AGs) or degenerative changes present, alone or in combination. Complete/substantial pain improvement after lidocaine administration is associated with disk state, radial defect (RT and AG), and RT-into-PAT.