How to Diagnose Back Pain From Degenerative Disc Disease - Lumbar Discogram and Imaging Studies
The intervertebral lumbar disc is made up of two parts that are analogous to a jelly donut. The inner part, the jelly, is called the nucleus pulposus and does not have the capacity to feel pain. The outer part, the anulus fibrosus, does have nerve endings and if they are injured the individual can have acute and potentially chronic back pain as a result.
When a patient has back pain, the work up includes the following.
- History and Physical Examination - Usually the patient has pain that is situated in the lower back, and often aggraved during sitting activities and flexion. Studies have shown flexion positions actually increase pressure on the lumbar disc.
- X-rays - Plain radiographs are a standard primary imaging work up. Plain films can show degenerative disc disease as a decreased space between the vertebrae so there is less space between the bones. Therefore, this is an indirect diagnosis. Keep in mind that the x-rays may show a decrease in disc height that reflects degenerative disc disease but not actually be the source of one's pain.
- MRI - A Magnetic Resonance Image, or MRI as it is commonly called, is very good at detecting differences in the soft tissues of the musculoskeletal system. If a lumbar disk is degenerated, the MRI will detect the loss of water and the disc will show up dark on the scan. Also an MRI can sometimes show a tear in the outer part of the lumbar disk, the anulus. As with x-rays, an MRI can suggest that a lumbar disc that is degenerative may be producing back pain, but may just be an incidental finding.
- Lumbar Discogram - A diskogram is a study that is meant to define if the lumbar disc is the source of back pain. The study is done under sedation, however, the patient cannot be completely put out since the physician needs input from the patient during the study. Typically a control level is included at a level thought to be normal. The physician places a needle into the disc space and injects dye along with fluid. This fluid is designed to increase pressure in the disk space and produce pain from the degenerated disc. There are three potential answers. One is the patient has no pain. Two is the patient has pain from the fluid that is unlike what he experiences on a daily basis. That is considered a negative study at that level. Three is the patient has the exact pain he or she experiences on a daily basis. That is considered a positive study. A discogram therefore has no therapeutic benefit and is not designed to alleviate pain, it actually creates it! The study serves a diagnostic benefit for pre-operative planning.
At the current time the studies used to diagnose degenerative disc disease, called DDD, represent the best modern medicine has to offer. There is not one study that is definitive.
David L. Greene, MD is CEO of Preferred Pain Center in Phoenix, Arizona which serves the Phoenix and Scottsdale Az metropolitan and surrounding areas. He can be reached at email@example.com and (602) 507-6550.
Preferred Pain Center is a Comprehensive Pain Center including Medical and Interventional Pain Management, Chiropractic, Physical Therapy, Spinal Decompression Therapy, Naturopathic Medicine, and Manipulation Under Anesthesia. The website is http://www.preferredpaincenter.com and the Blog of Pain is http://blog.preferredpaincenter.com
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