Ultrasonic Imaging of Lumbar Discs Combined With Vibration Pain Provocation Compared With Discography in the Diagnosis of Internal Anular Fissures of the Lumbar Spine

Abstract

STUDY DESIGN: The diagnostic information achieved by a combination of ultrasonographic imaging of discs and local bony vibration of lumbar vertebrae was compared to that obtained by discographic imaging and pain provocation. OBJECTIVES: The purpose of this study was to find a noninvasive method for spine diagnostics to replace expensive and invasive methods such as discography. SUMMARY OF BACKGROUND DATA: Internal anular fissures of the lumbar discs have been shown to be a source of back pain. Intradiscal changes associated with disc degeneration can be imaged by ultrasonography. The bony vibration test of spinal processes has shown to correlate well with discographic pain provocation tests in cases of internal anular ruptures. Discographic examination of the spine is the only widely accepted diagnostic method that combines pathoanatomic changes and patients' pain. METHODS: Patients with back pain in this study were examined by means of ultrasonography, bony vibration stimulation, and discography. The three lowest lumbar discs were examined. RESULTS: In the cases of intradiscal ultrasound findings, the vibration provocation test showed a sensitivity of 0.90 and a specificity of 0.75 compared to the discographic pain provocation test. In cases of total anular ruptures seen in ultrasound examination, the sensitivity and the specificity of the vibration pain provocation test were much lower, being 0.50 and 0.50, respectively. CONCLUSION: The combination of the two noninvasive methods provides a useful screening test for the evaluation of low back pain. The combination test can accurately depict painful disc degeneration with internal disc rupture and the use of discography can be limited to the cases suggesting total anular rupture in ultrasound examination.