Diagnostic criteria for discogenic low back pain

  Imaging examination; 1, CT examination; “discogenic low back pain” patients, the three layers of the intervertebral disc fibrous ring rupture, but the morphology of the change is not much, as if the lead hair of the tire is broken, but the shape is not changed, so the CT examination saw the disc normal or mildly inflated.  2, MR examination; in normal time, the human intervertebral disc contains 70%-80% water, discogenic back pain patients in the disc on the basis of degeneration, degeneration of the disc pathophysiological performance of diverse, but the main performance of dehydration, MR examination can clearly see the dehydrated disc in the T2-weighted phase performance of low signal, also known as “black disc This is also known as a “black disc”, while normal discs containing water show a high signal, also known as a “white disc”. Although the MR examination can see a “black disc”, it does not mean that the disc’s annulus fibrosus has ruptured. The CT examination is just a bulge, and the MR examination is just a “black disc”, but the CT and MR examinations cannot clearly diagnose discogenic back pain.  3.Intervertebral discography: Discography can clarify whether the intervertebral disc’s fibrous ring has ruptured.  The tissue structure of intervertebral disc is like an egg, the yolk is like the nucleus pulposus and the protein is like the fibrous ring. is intact and not ruptured. If the contrast agent measurement is >0.5 ml and the contrast agent is seen to reach the annulus fibrosus, it means that the annulus fibrosus of the disc is ruptured. The greater the contrast measurement, the more pronounced the rupture of the intervertebral disc’s annulus veneris.  When the fibrous annulus of the disc ruptures, the contrast agent can also bring the chemical substance of the nucleus pulposus into the spinal canal through the ruptured fibrous annulus, and most patients can experience pain, and this pain is also one of the criteria for diagnosing discogenic back pain.  Therefore, a clear diagnosis of discogenic low back pain can be made when there is little pressure felt in the hand during the injection of discography, the contrast agent enters the fibrous annulus, the contrast agent is measured >0.5 ml, and the patient has pain, etc.  However, the technical content of doing discography is relatively high. Usually discography is performed under X-ray fluoroscopic guidance or under CT guidance, and due to the limitations of the respective machines, the diagnostic accuracy is 60-75%, and 35%-40% may have false positives and false negatives.  By placing the mobile “C” fluoroscopy machine under the CT machine, we have increased the accuracy of discography to 98%.  Currently, discography is the gold standard for diagnosing “discogenic” low back pain.