Skeletal Radiology

, Volume 38, Issue 9, pp 877–885 | Cite as

Can magnetic resonance imaging accurately predict concordant pain provocation during provocative disc injection?

  • Chang Ho Kang
  • Yun Hwan KimEmail author
  • Sang-Heon Lee
  • Richard Derby
  • Jung Hyuk Kim
  • Kyoo Byung Chung
  • Deuk Jae Sung
Scientific Article



To correlate magnetic resonance (MR) image findings with pain response by provocation discography in patients with discogenic low back pain, with an emphasis on the combination analysis of a high intensity zone (HIZ) and disc contour abnormalities.

Materials and methods

Sixty-two patients (aged 17–68 years) with axial low back pain that was likely to be disc related underwent lumbar discography (178 discs tested). The MR images were evaluated for disc degeneration, disc contour abnormalities, HIZ, and endplate abnormalities. Based on the combination of an HIZ and disc contour abnormalities, four classes were determined: (1) normal or bulging disc without HIZ; (2) normal or bulging disc with HIZ; (3) disc protrusion without HIZ; (4) disc protrusion with HIZ. These MR image findings and a new combined MR classification were analyzed in the base of concordant pain determined by discography.


Disc protrusion with HIZ [sensitivity 45.5%; specificity 97.8%; positive predictive value (PPV), 87.0%] correlated significantly with concordant pain provocation (P < 0.01). A normal or bulging disc with HIZ was not associated with reproduction of pain. Disc degeneration (sensitivity 95.4%; specificity 38.8%; PPV 33.9%), disc protrusion (sensitivity 68.2%; specificity 80.6%; PPV 53.6%), and HIZ (sensitivity 56.8%; specificity 83.6%; PPV 53.2%) were not helpful in the identification of a disc with concordant pain.


The proposed MR classification is useful to predict a disc with concordant pain. Disc protrusion with HIZ on MR imaging predicted positive discography in patients with discogenic low back pain.


Discogenic low back pain High intensity zone Lumbar intervertebral disc Magnetic resonance imaging Discography 


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Copyright information

© ISS 2009

Authors and Affiliations

  • Chang Ho Kang
    • 1
  • Yun Hwan Kim
    • 1
    Email author
  • Sang-Heon Lee
    • 2
  • Richard Derby
    • 3
    • 4
  • Jung Hyuk Kim
    • 1
  • Kyoo Byung Chung
    • 1
  • Deuk Jae Sung
    • 1
  1. 1.Department of RadiologyKorea University Anam Hospital, Korea University College of MedicineSeoulKorea
  2. 2.Department of Physical Medicine and RehabilitationKorea University Anam Hospital, Korea University College of MedicineSeoulKorea
  3. 3.Spinal Diagnostics and Treatment CenterDaly CityUSA
  4. 4.Division of Physical Medicine and RehabilitationStanford University Medical CenterStanfordUSA

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