The Symptomatic Lumbar Disc in Patients with Low-Back Pain

Magnetic resonance imaging of abnormal lumbar discs in 115 symptomatic patients (184 discs) and 63 symptom-free controls (78 discs) have been compared. All symptomatic patients were proven to have discogenic pain at discography. Discs were classified into patterns 1-6 reflecting the progressive changes of nuclear degeneration as previously described. In the symptomatic patient, the more degenerate the disc the more likely it was responsible for pain (P < 0.001), but there was no statistically significant difference in the distribution of abnormal signal patterns between the two groups studied. A small number of patients in both populations demonstrated high signal from disc protrusions but this also could not be used as a predictor of pain. No abnormal lumbar disc signal pattern could be identified that specifically indicated whether a disc would be painful. Magnetic resonance imaging is accurate in determining nuclear anatomy, but until more suitable techniques become available, discography is still the only method for symptomatic assessment in low-back pain.