Pain and pathology in lumbar disc hernia.

The authors analyzed pain drawings of patients having lumbar disc surgery and tried to correlate pain pattern to disc pathology and level. Preoperatively, patients having spinal surgery were asked to draw on a standardized form the localization, postural variation, and modality of their pain. In this study, 185 consecutive patients with unilateral and unisegmental L4-L5 and L5-S1 hernias were analyzed. The pain drawings were coded and read blindly; each drawing was divided operationally into anatomic areas, and the type of pain symbol in each pixel was recorded, digitized, and analyzed by stepwise discriminant analysis. For predicting the level of the lesion, the most important variables were pain on the anterolateral aspect of the leg (L4-L5) and pain radiating to the posterior aspect of the foot (L5-S1). For predicting the grade of herniation, the most discriminative factors were pain radiating to the foot (sequestrated hernia) and bilateral back pain (protruded hernia). Pain drawing facilities communication and documentation. In addition, it is an aid to diagnose the level and degree of the hernia, and therefore is useful for selecting patients who might benefit from disc surgery. For scientific purposes, data are digitized easily, allowing analyses of large populations.