Are Outer Annular Fissures Stimulated During Diskography the Source of Diskogenic Low-Back Pain? An Analysis of Analgesic Diskography Data

Objective.  This study aimed to clarify whether painful annular fissures stimulated during provocation diskography are the likely source of diskogenic pain. Design.  A retrospective analysis was conducted of prospectively collected data. Setting.  Multidisciplinary, academic spine center. Patients.  The study was completed in a cohort of 28 consecutive patients were enrolled presenting with 6 months duration of axial low-back pain recalcitrant to physical therapy, oral analgesics, and epidural steroid injections and who have diskogenic pain based on history, exam, magnetic resonance imaging, and diskography. Interventions.  Subjects underwent provocation diskography and analgesic diskography utilizing a balloon-tipped intradiskal catheter allowing intradiskal injection of anesthetic. Outcome Measures.  Visual analog scale, finger-to-floor distance were utilized as outcome measures. Results.  80% of painful intervertebral disks as detected by provocation diskography were sufficiently anesthetized resulting in >50% reduction in low-back pain during analgesic diskography. Conclusion.  Diskogenic pain is in varying degrees caused by the sensitized nociocepters within annular tears.