RESULTS The results of this review confirm and help quantify the significant differences that existed in the terminology and all the areas of diagnosis and treatment of presumed discogenic pain .
Our findings show that suspected discogenic pain , despite its extensive affirmation in the literature and enormous re sources regularly devoted to it , currently lacks clear diagnostic criteria and uniform treatment or terminology
BACKGROUND CONTEXT Pain innate to intervertebral disc , often referred to as discogenic pain , is suspected by some authors to be the major source of chronic low back and neck pain .
Current management of suspected discogenic pain lacks st and ardized diagnosis , treatment , and terminology .
PURPOSE In an attempt to determine whether patterns existed that may facilitate st and ardization of care , we sought to analyze the terminologies used and the various modes of diagnosis and treatment of suspected discogenic pain .
2009 ISSLS Prize Winner: Does Discography Cause Accelerated Progression of Degeneration Changes in the Lumbar Disc: A Ten-Year Matched Cohort Study
Study Design . Prospect i ve , match-cohort study of disc degeneration progression over 10 years with and without baseline discography . Objectives . To compare progression of common degenerative findings between lumbar discs injected 10 years earlier with those same disc levels in matched subjects not exposed to discography . Summary of Background Data . Experimental disc puncture in animal and in vivo studies have demonstrated accelerated disc degeneration . Whether intradiscal diagnostic or treatment procedures used in clinical practice causes any damage to the punctured discs over time is currently unknown . Methods . Seventy-five subjects without serious low back pain illness underwent a protocol MRI and  an L3/4 , L4/5 , and L5/S1 discography examination in 1997 . A matched group was enrolled at the same time and underwent the same protocol MRI examination . Subjects were followed for 10 years . At 7 to 10 years after baseline assessment , eligible discography and controlled subjects underwent another protocol MRI examination . MRI grade rs , blind to group design ation , scored both groups for qualitative findings ( Pfirrmann grade , herniations , endplate changes , and high intensity zone ) . Loss of disc height and loss of disc signal were measured by quantitative methods . Results . Well matched cohorts , including 50 discography subjects and 52 control subjects , were contacted and met eligibility criteria for follow-up evaluation . In all grade d or measured parameters , discs that had been exposed to puncture and injection had greater progression of degenerative findings compared to control ( noninjected ) discs : progression of disc degeneration , 54 discs ( 35 % ) in the discography group compared to 21 ( 14 % ) in the control group ( P = 0.03 ) ; 55 new disc herniations in the discography group compared to 22 in the control group ( P = 0.0003 ) . New disc herniations were disproportionately found on the side of the anular puncture ( P = 0.0006 ) . The quantitative measures of disc height and disc signal also showed significantly greater loss of disc height ( P = 0.05 ) and signal intensity ( P = 0.001 ) in the discography disc compared to the control disc . Conclusion . Modern discography techniques using small gauge needle and limited pressurization result ed in accelerated disc degeneration , disc herniation , loss of disc height and signal and the development of reactive endplate changes compared to match-controls . Careful consideration of risk and benefit should be used in recommending procedures involving disc injection
RESULTS The results of this review confirm and help quantify the significant differences that existed in the terminology and all the areas of diagnosis and treatment of presumed discogenic pain .
Our findings show that suspected discogenic pain , despite its extensive affirmation in the literature and enormous re sources regularly devoted to it , currently lacks clear diagnostic criteria and uniform treatment or terminology
BACKGROUND CONTEXT Pain innate to intervertebral disc , often referred to as discogenic pain , is suspected by some authors to be the major source of chronic low back and neck pain .
Current management of suspected discogenic pain lacks st and ardized diagnosis , treatment , and terminology .
PURPOSE In an attempt to determine whether patterns existed that may facilitate st and ardization of care , we sought to analyze the terminologies used and the various modes of diagnosis and treatment of suspected discogenic pain .