PT  - JOURNAL ARTICLE
AU  - Bartynski, W.S.
AU  - Rothfus, W.E.
AU  - Kurs-Lasky, M.
TI  - Postdiskogram CT Features of Lidocaine-Sensitive and Lidocaine-Insensitive Severely Painful Disks at Provocation Lumbar Diskography
AID  - 10.3174/ajnr.A1151
DP  - 2008 Sep 01
TA  - American Journal of Neuroradiology
PG  - 1455--1460
VI  - 29
IP  - 8
4099  - http://www.ajnr.org/content/29/8/1455.short
4100  - http://www.ajnr.org/content/29/8/1455.full
SO  - Am. J. Neuroradiol.2008 Sep 01; 29
AB  - 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.