THE PREVALENCE AND CLINICAL-FEATURES OF INTERNAL DISC DISRUPTION IN PATIENTS WITH CHRONIC LOW-BACK-PAIN

Study Design. This was a cross-sectional analytic study of patients wi th chronic low back pain. Objective. To investigate whether the criter ia for internal disc disruption, as adopted by the International Assoc iation for the Study of Pain, could be satisfied in patients with chro nic low back pain and to test whether there were any conventional clin ical features that could identify this condition. Summary of Backgroun d Data. Internal disc disruption has been postulated as an important c ause of low back pain. To diagnose this condition, the International A ssociation for the Study of Pain taxonomy requires that pain be reprod uced on provocation discography and that computed tomography discograp hy reveal internal disc disruption, provided that as a control, stimul ation of at least one other disc fails to reproduce pain. Methods. Nin ety-two consecutive patients with chronic low back pain and no history of previous lumbar surgery were studied. Each patient underwent a sta ndard physical examination. Computed tomography discography was perfor med at a minimum of two levels. Results. The diagnostic criteria for i nternal disc disruption were fully satisfied in 39% of patients, most commonly at L5-S1 and L4-L5. None of the clinical tests used could dif ferentiate between those patients with internal disc disruption and ot her patients. Conclusions. A diagnosis of internal disc disruption can be made in a significant proportion of patients with chronic low back pain, but no conventional clinical test can discriminate patients wit h internal disc disruption from patients with other conditions.