The relative value of lumbar roentgenograms, metrizamide myelography, and discography in the assessment of patients with chronic low-back syndrome.

This prospective study evaluated the relative value of lumbar roentgenograms, metrizamide myelography, and discography in identifying structural sources for chronic low-back syndrome. One hundred and eight patients with chronic low-back syndrome were evaluated. Patients had not previously had pathology identified which could explain their pain. On discography, 83 patients (78%) had their pain reproduced at least one abnormal level, identifying a structural component to their pain. Only 22 patients (21%) had all levels of pathology identified by roentgenograms and an additional 17 (16%) had pathology appropriately identified by a combination of myelograms and roentgenograms. Using roentgenograms, myelography, and discography, organic pathology was identified which could explain the patient's symptoms in 100 of 108 patients (93%). Based on this study, we think discography is an important diagnostic tool for use in evaluating patients with chronic low-back syndrome. Discography is essential to adequately identify abnormal levels in patients being considered for fusions. Roentgenograms and myelograms are inadequate evaluation in this chronic pain group in that lack of organic pathology cannot be assumed in the presence of normal roentgenograms and myelograms.