Symptomatic Intradiscal Vacuum Phenomenon (original) (raw)
Related papers
The Internet Journal of Radiology, 2009
Gas production as a part of disc degeneration can occur but rarely causes nerve compression syndromes. We report a case of symptomatic epidural free gas accumulation originating from vacuum phenomenon in the intervertebral disc, causing lumbosacral radiculopathy. A 74-year-old woman suffered from sciatica for 6 months. The condition worsened in recent days, and a slight motor deficiency of the right S1 had developed. CT images demonstrated intradiscal vacuum phenomenon with degenerative disc disease, and accumulation of gas in the lumbar epidural space compressing the dural sac and nerve root. The patient treated conservatively and symptoms gradually resolved within 15 days.
Journal of Korean Neurosurgical Society, 2009
Objective : Few studies on the clinical spectrum of automated pressure-controlled discography (APCD)-defined positive discs have been reported to date. Thus, the present study was undertaken to analyze clinical parameters critical for diagnosis of discogenic pain and to correlate imaging findings with intradiscal pressures and pain responses in patients with APCD-positive discs. Methods : Twenty-three patients who showed APCD-positive discs were selected for analysis. CT discogram findings and the degrees of nuclear degeneration seen on MRI were analyzed in comparison to changes of intradiscal pressure that provoked pain responses; and clinical pain patterns and dynamic factors were evaluated in relation to pain provocation. Results : Low back pain (LBP), usually centralized, with diffuse leg pain was the most frequently reported pattern of pain in these patients. Overall, LBP was most commonly induced by sitting posture, however, standing was highly correlated with L5/S1 disc lesions (p < 0.01). MRI abnormalities were statistically correlated with grading of CT discogram results (p < 0.05); with most pain response observed in CT discogram Grades 3 and 4. Pain-provoking pressure was not statistically correlated with MRI grading. However, it was higher in Grade 3 than Grade 4. Conclusion : APCD-positive discs were demonstrated in patients reporting centralized low back pain with diffuse leg pain, aggravated by sitting and standing. MRI was helpful to assess the degree of nuclear degeneration, yet it could not guarantee exact localization of the painful discs. APCD was considered to be more useful than conventional discography for diagnosis of discogenic pain.
2020
Background: Lumbar vacuum phenomenon (VP) within the intervertebral disc has been classi ed based on CT imaging. We compared same-patient sagittal CT images and dynamic exion-extension x-rays to determine if there is a difference in the amount of vertebral instability present between three VP morphologies on CT. Methods: Anterior subluxation measurements on x-ray were compared with same-segment VP on CT images from the same patient when both ndings were present. VP were classi ed as spot, island, or linear. It was determined if there was a difference in the amount of anterior subluxation between the three morphologies. Secondary analysis looked at whether there was a difference in anterior subluxation between the three groups if patients had undergone a prior lumbar fusion surgery or not. Results: There was no difference in anterior subluxation between the three groups on dynamic exionextension x-rays. There was also no difference between the three groups on exion-extension x-rays when patients were separated based on if they had received or not received a previous lumbar fusion surgery. Conclusion: IVD VP morphology is not a useful indicator in determining vertebral instability preoperatively according to CT scan. Further ne-tuning of an IVD VP CT classi cation is needed to help radiologists and spine surgeons know when IVD VP presence is important.
Alteration of Disc Vacuum Contents During Prolonged Supine Positioning
Spine, 2007
Study Design. Consecutive study. Objective. To investigate the changes of disc signal in intradiscal vacuum phenomenon during prolonged supine MR imaging. Summary of Background Data. Increased T2 signal on MR imaging in intravertebral vacuum cleft during prolonged supine positioning has been described, but no sequential observation of the intervertebral discal signal change in intervertebral disc vacuum. Methods. Six women and 4 men (age range, 49-89 years; mean, 77 years) with low back pain and more than one level of intradiscal vacuum phenomenon underwent MR examinations at 0 minute, 1 hour, and 2 hours while remaining continuously supine. We recorded the original T2 signal intensity in the vacuum disc and subsequent alterations in the disc signals; they were scored 0 for signal void, 1 for equivocal or mild fluid intensity, or 2 for fluid signal intensity. Results. Vacuum phenomena affected 31 of 60 intervertebral discs (T11-T12 to L5-S1). In 9 patients, the signal intensity of the vacuum content progressively replaced by hyperintense fluid occurred in 25 discs (81%) after prolonged supine positioning, mostly from L3 to S1 levels. The location of fluid signal was central in 20 discs (65%), anterior in 4 (13%), and posterior in 1 (3%). Signal intensity was unchanged in 6 discs (19%). Fluid signal intensity was linear shape in 9 discs (29%), homogeneous in 5 (16%), and mixed in 11 (35%). Overall scores were 8, 26, and 38 at 0, 71, and 161 minutes, respectively. Conclusion. After prolonged supine positioning, fluidlike signal could be identified among the intradiscal vacuum by using T2 MR images. This in vivo observation suggested the possible pathway of fluid diffusion from surrounding tissues into degenerative discs.
2012
In the article, "Deleterious effects of discography radio-contrast solution on human annulus cell in vitro: changes in cell viability, proliferation, and apoptosis in exposed cells," Gruber et al. [1] demonstrated in vitro evidence of reduced proliferation and increased cell death of intervertebral disc cells exposed to isovue, the contrast agent commonly used in discography procedures. The study adds to the debate over comorbidities associated with structural disruption from discography procedures with relevant commentary by Kang [2] and provides additional information supporting the concept that discography injection procedures may result in accelerated disc degeneration by reducing disc cellularity. This commentary provides an overview on potential injuries induced by discography and contextualizes the findings of Gruber et al. with the broader discography literature. Discography is usually performed when other diagnostic modalities have failed to confirm the cause of a patient's low back pain (LBP). Radiographic techniques, especially magnetic resonance imaging, provide evidence of disc degeneration but cannot confirm that the degenerated disc is primarily responsible for a patient's LBP. Discography involves intradiscal injection of 1 to 3 cm 3 of radiopaque contrast materials, evaluation of the patient's clinical response (disc nociception), and postdiscography computed tomography scan to examine disc morphology (ie, annular tears). Even in the most ideal patients (eg, single-level disc degeneration, concordant discography, normal psychometrics, and no pending litigation), surgical success rates are estimated to be only 50% to 60% [3]. Investigators speculate that discography can lead to iatrogenic disc degeneration by injuring the normal control disc from the puncture of the annulus, the injection of contrast agents into the disc, and lack of annular repair. Carragee et al. [4] examined the progression of degenerative pathology between discs that had been subjected to discography with identical disc levels in a matched cohort that did not undergo discography with 7-to 10-year followup. Blinded magnetic resonance imaging evaluation revealed qualitative and quantitative changes in Pfirrmann grade, herniation, high intensity zones, end plate changes, disc height, and signal intensity. Discs that underwent discography had greater progression of degenerative findings compared with the noninjected control discs: 54 discs (35%) in the discography group compared with 21 (14%) in controls (p=.03). Furthermore, 55 new herniations in the discography group occurred compared with 22 in controls (p=.0003), and
Pain Practice, 2011
The development of diagnostic criteria and the use of provocative discography allow identifying the degenerative disc as causative structure for chronic lowback pain. Unfortunately, none of the available interventional treatment options have been demonstrated to be effective over a prolonged period of time for a considerable number of patients. Pathophysiological studies indicate sprouting of sensory nerves and inflammatory processes as underlying pain mechanisms. Pulsed radiofrequency (PRF) treatment in small and larger joints was described to reduce pain and improve healing by stimulating the immunology. Earlier findings of PRF applied in the disc annulus were promising. It is assumed that PRF applied in the nucleus would change the conductivity of nerve endings and provide a clinically relevant pain reduction. The application of the electric field of PRF in the disc may also activate the immune system, thus reducing the inflammation process of chronic pain. Pulsed radiofrequency in the nucleus was studied in 76 patients with discogenic pain confirmed by magnetic resonance imaging and provocative discography. At 3-month follow-up, 38% of the patients had > 50% pain reduction, at 12 month the effect is maintained in 29%. In patients with unsatisfactory pain relief 3 months after the intervention, secondary pain sources may have been revealed. The latter were treated accordingly. Of all patients, 56% had > 50% pain reduction 1 year after first treatment. Our findings suggest that PRF in the nucleus may be considered for patients with proven discogenic pain. A randomized controlled trial to confirm our findings is justified. n
Ozone Therapy, 2017
Chronic low back pain is a disease that most often affects people between 45 and 64 years. The incidence of low back pain goes from 60 to 90% and the annual incidence is 5%. Often low back pain is accompanied or replaced by an irradiated lower limb pain, configuring the symptomatology of lumboradiculalgia, whose most frequent cause is the disco-radicular conflict. The cause of the onset of pain, even excruciating, in cases of radicular compression of disc origin is not yet clear. Low back pain of disc origin is thought to be caused by direct mechanical compression factors; by indirect mechanical factors ischemia or venous stasis of vasa nervorum; and by type of immune-mediated inflammatory factors (reaction hernia) and/or biochemical evidence related to the disc type (the presence of substances which induce the inflammatory reaction). When a patient is suffering by chronic low back pain, apart from the algic problem, a series of changes in posture will occur, which contribute to wor...
Systematic review of tests to identify the disc, SIJ or facet joint as the source of low back pain
European Spine Journal, 2007
Clinical practice guidelines state that the tissue source of low back pain cannot be specified in the majority of patients. However, there has been no systematic review of the accuracy of diagnostic tests used to identify the source of low back pain. The aim of this systematic review was therefore to determine the diagnostic accuracy of tests available to clinicians to identify the disc, facet joint or sacroiliac joint (SIJ) as the source of low back pain. MEDLINE, EMBASE and CINAHL were searched up to February 2006 with citation tracking of eligible studies. Eligible studies compared index tests with an appropriate reference test (discography, facet joint or SIJ blocks or medial branch blocks) in patients with low back pain. Positive likelihood ratios (+LR) > 2 or negative likelihood ratios (-LR) < 0.5 were considered informative. Forty-one studies of moderate quality were included; 28 investigated the disc, 8 the facet joint and 7 the SIJ. Various features observed on MRI (high intensity zone, endplate changes and disc degeneration) produced infor-mative +LR (> 2) in the majority of studies increasing the probability of the disc being the low back pain source. However, heterogeneity of the data prevented pooling. +LR ranged from 1.5 to 5.9, 1.6 to 4.0, and 0.6 to 5.9 for high intensity zone, disc degeneration and endplate changes, respectively. Centralisation was the only clinical feature found to increase the likelihood of the disc as the source of pain: +LR = 2.8 (95%CI 1.4-5.3). Absence of degeneration on MRI was the only test found to reduce the likelihood of the disc as the source of pain: -LR = 0.21 (95%CI 0.12-0.35). While single manual tests of the SIJ were uninformative, their use in combination was informative with +LR of 3.2 (95%CI 2.3-4.4) and -LR of 0.29 (95%CI 0.12-0.35). None of the tests for facet joint pain were found to be informative. The results of this review demonstrate that tests do exist that change the probability of the disc or SIJ (but not the facet joint) as the source of low back pain. However, the changes in probability are usually small and at best moderate. The usefulness of these tests in clinical practice, particularly for guiding treatment selection, remains unclear.
Pakistan biomedical journal, 2022
Degenerative lumbar spine disease is a condition in which an intervertebral disk and surrounding spinal components are weakened due to age or a pathogenic cause [1]. Individuals with lumbar spine degenerative disease might be symptomatic and asymptomatic [2]. Individuals who are symptomatic may complain of back discomfort as back pain or radicular pain syndrome may have Sciatica [3,4]. Mechanical compression of neuronal components caused by disk herniation and biochemical and in ammatory causes are all potential origins of pain [5]. About 35% of people with no symptoms may show degenerative spine abnormalities such as disk degeneration, Modic alterations, disk bulges, spinal stenosis and facet joint arthropathy. Disk degeneration, Modic alterations, disk