Pain provocation at lumbar discography as analyzed by computed tomography/discography.

Pain provocation was analyzed in 1477 intervertebral discs in 523 patients subjected to lumbar computed tomography/discography. The relation between pain provocation and the degree of general degeneration and anular disruption assessed according to the Dallas Discogram Description as indices of intradiscal deterioration was investigated. Pain provocation was also evaluated after categorizing the discs by the clinical diagnosis. Pain provocation showed little relation to intradiscal deterioration, whereas a strong relation was found between it and herniated nucleus pulposus. in herniated nucleus pulposus, discs with extraligamentous extrusion or sequestration, large protrusions, maximum protrusion site at the nerve root portion, and herniation routes passing through the central portion of the disc showed a high pain provocation ratio. Pain provocation ratios of discs associated with spinal canal stenosis were extremely low.