CERVICAL DISCOGENIC PAIN - PROSPECTIVE CORRELATION OF MAGNETIC-RESONANCE-IMAGING AND DISCOGRAPHY IN ASYMPTOMATIC SUBJECTS AND PAIN SUFFERERS

Study Design. Asymptomatic subjects and chronic head/neck pain suffere rs were studied with high-field magnetic resonance imaging and cervica l discography to compare and correlate both tests. Objectives. To asse ss the accuracy of magnetic resonance imaging and discography in ident ifying the source(s) of cervical discogenic pain. Summary of Backgroun d Data. Previous retrospective studies describe a generally poor corre lation between magnetic resonance imaging and provocative discography in the cervical spine. Methods. Ten lifelong asymptomatic subjects and 10 nonlitigious chronic neck/head pain patients underwent discography at C3-C4 through C6-C7 after magnetic resonance imaging. Disc morphol ogy and provoked responses were recorded at each level studied. Result s. Of 20 normal discs by magnetic resonance from the asymptomatic volu nteers, 17 proved to have painless anular tears discographically. The average response per disc (N = 40) for this group was 2.42, compared t o 5.2 (N = 40) for the neck pain group. In the pain patients, 11 discs appeared normal at magnetic resonance imaging, whereas 10 of these pr oved to have anular tears discographically. Two of these 10 proved con cordantly painful with intensity ratings of at least 7/10. Discographi cally normal discs (N = 8) were never painful (both groups), whereas i ntensely painful discs all exhibited tears of both the inner and outer aspects of the anulus. Conclusions. Significant cervical disc anular tears often escape magnetic resonance imaging detection, and magnetic resonance imaging cannot reliably identify the source(s) of cervical d iscogenic pain.