Availability of Intradiscal Injection of Marcaine as a Pain Relief Test for Diagnosis of Internal Disc Disruption

Abstract

Study Design: A retrospective study Objectives: To investigate the availability of an intradiscal injection of marcaine as a pain relief test to enhance specificity in the diagnosis of IDD. Summary of Literature Review: The diagnosis and treatment of IDD have been controversial. A discography, which has been widely used for the diagnosis of IDD, has many problems that might result in a faulty diagnosis. Materials and Methods: Twenty nine patients, with an average age and duration of symptom of 36.9 years (22 to 46 years) and 5 years 1 month (6 months to 10 years), respectively, were reviewed. After the discography, the marcaine was injected. Based on the responses after the injection, the group was sub-divided into a further two groups. Group A (n=19): transient pain relief and surgical treatment was performed. Group B (n=10): no pain relief and conservative treatment was performed. An analysis to examine the correlation between the response to marcaine and age, duration of symptom, subjective pain level, number of disc degeneration and high intensity zone was also performed, and the clinical results quantified. Results: The agreement rate between the discography and response to marcaine was 55.2%. The longer the symptom duration, the more meaningful were the responses to the marcaine injection (p<0.05). The result of surgical treatment was important statistically, as the pain was relieved from 8.6±0.97 to 1.8±0.42 points, and the ODI decreased from 68±16.92 to 30±9.97% (p<0.05). Conclusions: An intradiscal injection of marcaine, as the pain relief test, can enhance the specificity for the diagnosis of IDD.