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Lumbosacral Discogenic Pain Syndrome Workup

  • Author: Robert E Windsor, MD, FAAPMR, FAAEM, FAAPM; Chief Editor: Craig C Young, MD  more...
Updated: Aug 19, 2016

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.[7]

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 difficulty is differentiating between a pathologically degenerate disc and a physiologically aging one.

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.

Gadolinium-DTPA enhanced MRI is also being proposed as a viable alternative, showing a signal flare at the site of granulation tissue within a healing or healed full-thickness tear.[8]

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.

Contributor Information and Disclosures

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, Texas Medical Association

Disclosure: Nothing to disclose.


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, North American Spine Society, International Spine Intervention Society

Disclosure: Nothing to disclose.

Erik D Hiester, DO Fellow in Interventional Pain Management, Georgia Pain Physicians, Emory University School of Medicine

Erik D Hiester, DO is a member of the following medical societies: American Academy of Family Physicians, American Medical Association, American Osteopathic Association, American Pain Society

Disclosure: Nothing to disclose.

R Blake Windsor, MD Resident Physician, Department of Pediatrics, Boston Children's Hospital and Boston Medical Center

R Blake Windsor, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, Massachusetts Medical Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

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, American Orthopaedic Society for Sports Medicine

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, 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, Phi Beta Kappa

Disclosure: Nothing to disclose.

Additional Contributors

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, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

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