BONY VIBRATION STIMULATION TEST COMBINED WITH MAGNETIC-RESONANCE-IMAGING - CAN DISCOGRAPHY BE REPLACED

Study Design. The results of two noninvasive methods, magnetic resonan ce imaging and a bony vibration test, were compared with discographic pain provocation findings. Objectives. To evaluate whether the combina tion of magnetic resonance imaging and vibration pain provocation test s could be used to replace discography in low back pain diagnostics. S ummary of Background Data. Magnetic resonance imaging gives a wealth o f visual information on anatomic changes of the spine with often unkno wn clinical significance. Discographic examination of the spine is sti ll the only widely accepted diagnostic method that can relate the path oanatomic changes to the patient's clinical pain. Internal anular rupt ure has been shown to be one of the sources of back pain. The bony vib ration test of the spinal processes has been shown correlate well with discographic pain provocation tests in cases of internal anular ruptu re. Methods. The three lowest lumbar discs of 33 patients with back pa in were examined by means of magnetic resonance imaging and a bony vib ration stimulation test, and the results were compared with those from computed tomography-discography. Results. In cases of intradiscal mag netic resonance imaging findings, the vibration provocation test showe d a sensitivity of 0.88 and a specificity of 0.50 compared with the di scographic pain provocation test. If the patients with previous back s urgery were excluded, the specificity was 0.75. In the cases of total anular rupture, the sensitivity was 0.50, and the specificity was 0.33 . Conclusion. The combination of the two noninvasive methods, vibratio n stimulation and magnetic resonance imaging, gives more information o n the origin of the back pain than magnetic resonance imaging alone. T he pathoanatomic changes seen in magnetic resonance imaging can be cor related with the patient's disorder more reliably using the vibration provocation lest in the cases of partial anular ruptures. The use of d iscography can be limited mostly to cases with total anular ruptures d etected by magnetic resonance imaging.