Major advances in the techniques of discography since 1968, in
conjunction with major strides in the evaluation of pain in recent years,
prompted a study in which Holt's work on the specificity of discography was
replicated and extended. For the present study, seven patients who had
low-back pain and ten volunteers who had been carefully screened, with a
questionnaire and a physical examination, to ensure that they had no
history of problems with the back, had an injection at three levels, and
all sessions were videotaped. After each injection, the participant was
interviewed about the pattern and intensity of the pain, and then the discs
were imaged with computed tomography. Five raters, who were blind to the
condition of the participant, graded each disc as normal or abnormal on the
basis of findings on magnetic resonance images that had been made before
the injection and computed tomography (discography) were done. There was
only one disagreement between the ratings that were made on the basis of
the magnetic resonance images and those that were made on the basis of the
discograms. Each participant's pain-related response was evaluated
independently by two raters who viewed the videotapes of the discography.
Inter-rater reliability was 0.99, 0.93, and 0.88 for the evaluation of
intensity of the pain, pain-related behavior, and similarity of the pain to
pain that the subject had had before the injection. In the asymptomatic
individuals, the discogram was interpreted as abnormal for 17 per cent
(five) of the thirty discs and for five of the ten subjects.(ABSTRACT
TRUNCATED AT 250 WORDS)