Annular Tears: Correlating Discogram and Endoscopic Findings with Electrothermal Response
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It is generally accepted that pain nociceptors in the outer annulus is a source of discogenic pain in the lumbar disc. When these ﬁbers are disrupted and do not heal, chronic chemical as well as mechanical back pain can result. April and Boduk reported on the "high intensity zone" on a T2 weighted MRI of the lumbar spine. They concluded that this ﬁnding can be reliably detected, is diagnostic of an annular tear, and correlates highly with discogenic pain.
Others, however, question the relationship of the association between HIZ and back pain. This prospective study correlates pain provocation diagnosed with provocative discography with annular tear patterns, and its response to controlled thermal shrinkage of the disc and annular ﬁbers using a ﬂexible radio frequency probe (Oratec Interventions, Inc.).