eMedicine Specialties > Sports Medicine > Spine

Lumbosacral Discogenic Pain Syndrome: Differential Diagnoses & Workup

Author: Robert E Windsor, MD, FAAPMR, FAAEM, FAAPM, President and Director, Georgia Pain Physicians, PC; Clinical Associate Professor, Department of Physical Medicine and Rehabilitation, Emory University School of Medicine
Coauthor(s): Kevin P Sullivan, MD, Consulting Staff, The Boston Spine Group; Erik D Hiester, DO, Fellow in Interventional Pain Management, Emory Medical School/Georgia Pain Physicians
Contributor Information and Disclosures

Updated: Jan 6, 2010

Differential Diagnoses

Lumbosacral Disc Injuries
Lumbosacral Facet Syndrome
Lumbosacral Radiculopathy
Lumbosacral Spondylolisthesis
Lumbosacral Spondylolysis

Workup

Laboratory Studies

  • Laboratory evaluation is primarily used to identify underlying inflammatory, infectious, neoplastic, or nonspinal causes of low back pain. Such studies may include CBC, rheumatologic screening, and neuroendocrine testing.

Imaging Studies

  • MRI is the best noninvasive test for detecting IDD. Note, however, that the relationship between MRI depicted IDD and low back pain remains poorly understood.
    • Generally, MRI demonstrates degenerative changes within the disc, such as annular fissures and reduced signal intensity, indicative of reduced water content. These changes, of course, are not specific for IDD, although discs with IDD do demonstrate degenerative changes.
    • The most specific MRI hallmark for IDD is the high-intensity zone (HIZ). This is a high-intensity signal, usually at the posterior apex of an annular fissure. The significance of the HIZ in regard to discogenic low back pain is still controversial. Aprill and Bogduk initially described the HIZ and reviewed a subset of 41 patients who were also evaluated with CT discography. In this study, the presence of the HIZ was strongly correlated to concordant pain. However, a study by Horton and Daftari involving 63 discs in 25 patients did not support a high correlation of the HIZ with concordant provoked pain.
  • Discography is the criterion standard for detecting IDD. It is somewhat invasive but is the only tool for accurately demonstrating whether a disc is painful or not. However, the efficacy of discography is controversial, and proper interpretation requires knowledge of the pathologic condition, an in-depth appreciation of the patient, and proper technique.

More on Lumbosacral Discogenic Pain Syndrome

Overview: Lumbosacral Discogenic Pain Syndrome
Differential Diagnoses & Workup: Lumbosacral Discogenic Pain Syndrome
Treatment & Medication: Lumbosacral Discogenic Pain Syndrome
Follow-up: Lumbosacral Discogenic Pain Syndrome
References
Further Reading
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Further Reading

Clinical guidelines:
 ACR Appropriateness Criteria® low back pain. American College of Radiology - Medical Specialty Society. 1996 (revised 2008). 7 pages. NGC:007005

Assessment: use of epidural steroid injections to treat radicular lumbosacral pain. Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. American Academy of Neurology - Medical Specialty Society. 2007 Mar 6. 7 pages. NGC:005580

Guidelines for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 8: lumbar fusion for disc herniation and radiculopathy. American Association of Neurological Surgeons - Medical Specialty Society
Congress of Neurological Surgeons - Professional Association. 2005 Jun. 6 pages. NGC:005369

Low back disorders. American College of Occupational and Environmental Medicine - Medical Specialty Society. 1997 (revised 2007). 366 pages. NGC:006456

Clinical trials:
A 3-arm Multi-center, Randomized Controlled Study Comparing Transforaminal Corticosteroid, Transforaminal Etanercept and Transforaminal Saline for Lumbosacral Radiculopathy

Lumbar Disc Herniation Outcome Measures

World Health Organization Disability Assessment Schedule (WHODAS-II) for Patients With Symptomatic Lumbar Disc Herniation

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Keywords

lumbosacral discogenic pain syndrome, low back pain, lower back pain, herniated disc, herniated disk, disc herniation, lumbar pain, lumbar back pain, lumbosacral spine, internal disc disruption, lumbar degenerative disc disease, lumbar disc bulge, lumbar disc herniation, lumbar disc protrusion, lumbar disc extrusion, lumbar discogenic pain syndrome, lumbar radiculopathy

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Contributor Information and Disclosures

Author

Robert E Windsor, MD, FAAPMR, FAAEM, FAAPM, President and Director, Georgia Pain Physicians, PC; Clinical Associate Professor, Department of Physical Medicine and Rehabilitation, Emory University School of Medicine
Robert E Windsor, MD, FAAPMR, FAAEM, FAAPM is a member of the following medical societies: American Academy of Pain Medicine, American Academy of Physical Medicine and Rehabilitation, American College of Sports Medicine, American Medical Association, International Association for the Study of Pain, and Texas Medical Association
Disclosure: Nothing to disclose.

Coauthor(s)

Kevin P Sullivan, MD, Consulting Staff, The Boston Spine Group
Kevin P Sullivan, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, International Spine Intervention Society, and North American Spine Society
Disclosure: BioAssets Development Corp Consulting fee Consulting

Erik D Hiester, DO, Fellow in Interventional Pain Management, Emory Medical School/Georgia Pain Physicians
Erik D Hiester, DO is a member of the following medical societies: American Academy of Family Physicians, American Medical Association, American Osteopathic Association, and American Pain Society
Disclosure: Nothing to disclose.

Medical Editor

Andrew D Perron, MD, Residency Director, Department of Emergency Medicine, Maine Medical Center
Andrew D Perron, MD is a member of the following medical societies: American College of Emergency Physicians, American College of Sports Medicine, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Henry T Goitz, MD, Academic Chair and Associate Director, Detroit Medical Center Sports Medicine Institute; Director, Education, Research, and Injury Prevention Center; Co-Director, Orthopaedic Sports Medicine Fellowship
Henry T Goitz, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons and American Orthopaedic Society for Sports Medicine
Disclosure: Nothing to disclose.

CME Editor

Jon B Whitehurst, MD, Clinical Instructor of Surgery, University of Illinois College of Medicine; Partner and Executive Board Member, Rockford Orthopedic Associates; Orthopedic Chairman, Rockford Memorial Hospital
Jon B Whitehurst, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America
Disclosure: Nothing to disclose.

Chief Editor

Craig C Young, MD, Professor, Departments of Orthopedic Surgery and Community and Family Medicine, Medical Director of Sports Medicine, Sports Medicine Fellowship Director, Medical College of Wisconsin
Craig C Young, MD is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, American Medical Society for Sports Medicine, and Phi Beta Kappa
Disclosure: Nothing to disclose.

 
 
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