Search

Purpose: To assess the effect of the epidural steroid injection for patients suspected of having an internal disc disruption. Materials and Methods: Thirteen patients at the pain intervention clinic that received a lumbar interlaminar epidural steroid injection and were suspected of having an internal disc disruption were prospectively enrolled in this study. The treatment outcome was assessed using a 5-point patient satisfaction scale (no pain, much improved, slightly improved, no effect, aggravated) two weeks after injection. A successful outcome required a patient satisfaction scale of "much improved" or "no pain". All patients received follow-up for two months. Two radiologists evaluated the presence of HIZ (high intensity zone), a dark disc by MR (n = 10) and a diffuse bulging disc by CT (n = 3). Results: Nine (69%) of the 13 patients achieved a successful outcome two weeks after injection. These nine patients showed no recurrence during the two months months follow-up. Of the 22 abnormal discs demonstrated by MRI and CT, MRI showed a dark disc in six patients and HIZ in 13 patients. CT showed diffuse bulging in three discs. Nine of 10 patients showed at least one HIZ. Conclusion: An lumbar interlaminar epidural steroid injection might be an effective tool for managing patients suspected of having an internal disc disruption.

Purpose: The aim of this study was to describe the method and the value of cervical discography as correlated with the MR findings. Materials and Methods: Twenty-one discs in 11 consecutive patients who underwent cervical discography were analyzed. MR and CT discography (CTD) were performed in all patients. Discography was performed after swallowing barium for visualizing the pharynx and the esophagus to prevent penetration. We also analyzed the preceding causes of the subjects'cervical pain. The results of the pain provocation test were classified into concordant pain, discordant pain and a negative test. MRI was analyzed according to the T2-signal intensity (SI) of the disc, disc height, annular bulging and disc herniation. The CTD was analyzed for degeneration or radial tear of the disc, epidural leakage of the contrast agent and pooling of the contrast agent at the periphery of the disc. The pain provocation tests were correlated with the MR and CTD findings. We used the chi-square test to analyze the results. Results: Concordant pain was observed in 14 cases, discordant pain in 3 cases and there were negative tests in 4 cases. There were no complications related to the procedure. Four patients had undergone anterior cervical fusion and four patients had pain that developed after traffic injuries. The decreased T2-SI and annular bulging on MRI, disc degeneration and peripheral pooling of the contrast agent on CT were significantly correlated with pain provocation. Conclusion: When the diagnosis of disc disease is difficult with performing MRI, cervical discography with using swallowed barium solution to reduce the penetration of the esophagus or hypopharynx may play be helpful. The decreased T2-SI and annular bulging on MRI correlated significantly with a positive result on the pain provocation test.