Pain improvement after intradiskal lidocaine administration in provocation lumbar diskography: association with diskographic contrast leakage.

BACKGROUND AND PURPOSE Our aim was to evaluate the relationship of pain reduction, after intradiskal lidocaine administration during provocation lumbar diskography, to the presence of contrast leakage on postdiskographic imaging. MATERIALS AND METHODS Intradiskal lidocaine was injected at 182 significantly painful disk levels in 111 patients. The clinical records and imaging studies were reviewed for response to the lidocaine injection and for the presence/absence of diskographic contrast leakage on postdiskographic images and CT. Pain response was assigned the following grades: 1) complete or substantial improvement, 2) partial improvement, or 3) no significant improvement after lidocaine administration. Fluoroscopic imaging and postdiskographic CT were evaluated for the presence or absence of contrast leakage. RESULTS Eighty-two (45%) significantly painful treated disks were contained, and 100 (55%) demonstrated contrast leakage. In leaking disks, 74 (74%) demonstrated complete or near-complete pain reduction after lidocaine administration, 15 (15%) demonstrated partial improvement, and 11 (11%) demonstrated no pain relief. In contained disks, 56 disks (69%) demonstrated no improvement after lidocaine administration, 9 (11%) demonstrating partial relief, and 17 (20%) demonstrated complete or substantial improvement. Results comparing leaking disks versus contained disks and complete versus no improvement were statistically significant (P<.001). CONCLUSION Painful disks exhibiting diskographic leakage tend to be highly responsive to intradiskal lidocaine administration, whereas painful disks without diskographic leakage tend not to improve. This observation has implications with respect to targeting the origin of a patient's back pain and may have specific implications with respect to choice of treatment.