The results of this review demonstrate that tests do exist that change the probability of the disc or SIJ ( but not the facet joint ) as the source of low back pain .
Clinical practice guidelines state that the tissue source of low back pain can not be specified in the majority of patients .
However , there has been no systematic review of the accuracy of diagnostic tests used to identify the source of low back pain .
The aim of this systematic review was therefore to determine the diagnostic accuracy of tests available to clinicians to identify the disc , facet joint or sacroiliac joint ( SIJ ) as the source of low back pain .
Lumbar disc high-intensity zone: the value and significance of provocative discography in the determination of the discogenic pain source
Abstract Disagreement still exists in the literature as to the significance of the high-intensity zone ( HIZ ) demonstrated on magnetic resonance imaging ( MRI ) as a potential pain ¶indicator in patients with low back pain . A prospect i ve blind study was therefore conducted to evaluate the lumbar disc high-intensity zone with the pain provocation response of lumbar discography . Consecutive patients with low back pain unresponsive to conservative treatment and being considered for spinal fusion were subjected to MRI followed by lumbar discography as a pre-operative assessment . The discographer was blinded to the results of the MRI scans . We used the chi-squared test to analyse our results . Ninety-two HIZs were identified in 73 patients , mainly occurring at L4/5 ( 48 % ) and L5/S1 ( 35 % ) . Significant correlation was found between abnormal disc morphology and the HIZ ( P < 0.001 ) . In morphologically abnormal discs ( grade s 3 , 4 and 5 ) , there was a significant correlation between the HIZ and exact or similar pain reproduction ( P < 0.001 ) . The sensitivity , specificity and positive predictive value for pain reproduction were high , at 81 % , 79 % and 87 % respectively . The nature of the HIZ remains unknown , but it may represent an area of secondary inflammation as a result of an annular tear . We conclude from our study that the lumbar disc HIZ observed on MRI in patients with low back pain is likely to represent painful internal disc disruption
The results of this review demonstrate that tests do exist that change the probability of the disc or SIJ ( but not the facet joint ) as the source of low back pain .
Clinical practice guidelines state that the tissue source of low back pain can not be specified in the majority of patients .
However , there has been no systematic review of the accuracy of diagnostic tests used to identify the source of low back pain .
The aim of this systematic review was therefore to determine the diagnostic accuracy of tests available to clinicians to identify the disc , facet joint or sacroiliac joint ( SIJ ) as the source of low back pain .