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Chiropractic Research Review

Site of LBP Not Correlated to Location of Annular Tear

Fissures in the nucleus pulposus of the intervertebral disc and extending to the outer one-third of the annulus fibrosus are thought to be the pain-generating source during provocative lumbar discography (PLD).

Many doctors use PLD as a presurgical tool to determine what surgical procedure should be performed and the specific spinal level it should be performed at. It is assumed by many health experts that the side of a patients low back pain automatically corresponds with the location of the annular tear; no studies have provided convincing results of this relationship, however.

Forty CT scans were reviewed by the authors and a spine radiologist to decide which scans showed annular tears and where they were located (right, left, central or bilateral). The data were then compared to the location of pain conveyed by the corresponding discography.

No correlation was found between the side of annular tear and site of pain; statistical analysis showed only a random correlation between each factor.
The study raises concerns related to the current evaluation of annular tears. Procedures such as intradiscal electrothermal therapy (IDET) and epidural steroid injections (ESI) are performed only on the same side as a patient's pain, which could be insufficient if there is no pain-tear relationship.

Slipman CW, Patel RK, Zhang L, et al. Side of symptomatic annular tear and site of low back pain: Is there a correlation? Spine (Online) 2001:26, pp. e165-e169.

Chiropractic Research Review

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