Annular Disruption Research Articles

Pressure Measurements in Herniated Lumbar Disks

This prospective observational study of 85 herniated disks was conducted to investigate the relationship between diskomanometry and radiologic and clinical parameters. The mean injection pressure (P0) was 282 kPa, the residual pressure after 60 s (P60) was 181 kPa, and the loss of pressure (LOP) was 34%. P0 and P60 were moderately intercorrelated (r = 0.51). The following associations were significant: low P0 and P60 in advanced annular degeneration and disruption; low P60 and great LOP in large hernias and narrow disks. P0 and P60 were not associated with the pain response at diskography, magnetic resonance signal intensity, or patient age, sex, weight, body mass index, type of occupation, or duration of symptoms. Diskomanometric data seem to be influenced by the level of annular degeneration and disruption, size of herniation and height of the disk space.

Bacillus licheniformis prosthetic aortic valve endocarditis

A 73-year old man developed an acute prosthetic aortic valve dehiscence for which emergent operation was undertaken. The intraoperative evidence of an aortic annular disruption and of a subannular abscess led to the hypothesis that an endocarditis process was involved. The aortic valve was replaced with a stentless porcine bioprosthesis. Cultures taken intraoperatively from the aortic area had a pure growth of aerobic, spore-forming, gram-positive bacilli identified as Bacillus licheniformis. The patient responded to specific antibiotic therapy with no relapse at a 20-month follow-up. The potentiality of B. licheniformis as a pathogen should be reconsidered.

High-intensity zone: a diagnostic sign of painful lumbar disc on magnetic resonance imaging.

The prevalence, validity and reliability of high-intensity zones in the annulus fibrosus seen on T2-weighted magnetic resonance images of patients with intractable low-back pain were determined. This sign was readily recognized by two independent observers. It occurred in 28% of 500 patients undergoing magnetic resonance imaging for back pain. The presence of a high-intensity zone correlated significantly with the presence of Grade 4 annular disruption and with reproduction of the patient's pain. Its sensitivity as a sign of either annular disruption or pain was modest but its specificity was high, and its positive predictive value for a severely disrupted, symptomatic disc was 86%. This sign is diagnostic of painful internal disc disruption.

Lumbar Disc Degeneration

Computed tomography (CT) images of 59 discs in 30 patients suffering from low back pain were compared with CT/discography images of the same discs in order to assess the correlation between intradiscal damage and changes in annular configuration and density. The discs were graded in CT as not bulging, slight protrusion, advanced protrusion or disc herniation, and were checked for local areas of hypodensity. General degeneration and annular disruption in CT/discography were evaluated separately according to the Dallas Discogram Description, on a scale of non-existent, slight, moderate, or severe. Most discs with a slight protrusion in CT showed severe annular disruption in CT/discography. Discs with advanced protrusion showed in addition a severe general degeneration. Disc herniation was associated only with severe annular disruption. Local hypodensity proved to be a specific but insensitive sign of annular disruption. It is concluded that a bulging disc is a sign of intradiscal damage and should be noted even when there is no nerve entrapment present.

Lumbar Disc Degeneration

Computed tomography (CT) images of 59 discs in 30 patients suffering from low back pain were compared with CT/discography images of the same discs in order to assess the correlation between intradiscal damage and changes in annular configuration and density. The discs were graded in CT as not bulging, slight protrusion, advanced protrusion or disc herniation, and were checked for local areas of hypodensity. General degeneration and annular disruption in CT/discography were evaluated separately according to the Dallas Discogram Description, on a scale of non-existent, slight, moderate, or severe. Most discs with a slight protrusion in CT showed severe annular disruption in CT/discography. Discs with advanced protrusion showed in addition a severe general degeneration. Disc herniation was associated only with severe annular disruption. Local hypodensity proved to be a specific but insensitive sign of annular disruption. It is concluded that a bulging disc is a sign of intradiscal damage and should be noted even when there is no nerve entrapment present.

Disc deterioration in low-back syndromes. A prospective, multi-center CT/discography study.

Disc deterioration and pain provocation in different low-back pain syndromes was studied using computed tomography (CT) discography. Data were prospectively collected for 300 patients (816 discs). Patients were classified by their pre-discography diagnosis of disc herniation (DH), degenerated disc (DD), lumbar syndrome (LS), lumbar radicular syndrome (LRS), or other. The CT/discograms were classified by discographic pain response, the amount of degeneration and annular disruption. Eighty-two percent of DH patients, 80% of DD, 56% of LS, and 59% of LRS patients had both positive discographic pain provocation and moderate or severe disc deterioration. The study indicates that intradiscal pathology plays a major role in nonspecific low-back pain syndromes.

Surgical Repair of Annular Disruption Following Percutaneous Balloon Aortic Valvuloplasty

Percutaneous balloon aortic valvuloplasty for aortic stenosis is being performed with increasing frequency. Disruption-induced acute aortic insufficiency is an infrequent and unreported complication. We report one such case and describe its successful surgical repair.

Dallas Discogram Description A New Classification of CT/Discography in Low-back Disorders

A new classification method for CT/discography was developed. The Dallas discogram description (DDD) related five separate categories of information. Degeneration and annular disruption were regarded as separate phenomena. Additionally, provoked pain response, contrast volume, and miscellaneous information were recorded. Discogram findings of 59 patients with low-back and/or leg pain were graded according to the new method and compared with standard methods using routine anteroposterior and lateral discographic images. Findings from routine discography and CT/discography were graded and correlated with myelographic and plain computerized axial tomography (CAT) scans. This study demonstrated that the contrast-enhanced axial view provided by CT/discography served as a useful projection for demonstrating disc pathology. CT/discography analyzed according to DDD offered a more sensitive discriminator of disc degeneration from annular disruption (disc protrusion/leaking). This evaluation can be recommended as the procedure of choice when revision of spine surgery is considered or when there is an equivocal or negative correlation between clinical information and myelography or CAT scan.

The relationship of pain provocation to lumbar disc deterioration as seen by CT/discography.

The CT/discographic findings from 225 discs in 91 low-back pain patients were compared to the pain provocation during the injection of contrast into the disc. The radiographic appearance of disc deterioration demonstrating disc degeneration and annular disruption of each disc was classified separately using a fourpoint scale: normal, slight, moderate, or severe. Pain reaction to the discogram at each level was recorded as follows: no pain, dissimilar pain, similar pain, or exact reproduction of the patient's clinical pain. This more precise analysis demonstrated a significant relationship between pain and deterioration of discs. The CT/discogram presents an axial view of the disc that allows a subgrouping of disc deterioration that can discriminate between peripheral deterioration (degeneration) and internal deterioration (disruption). The disruption supposedly occurs earlier and is more likely to be the source of exact pain reproduction.