| There are many challenges for physicians treating patients with low back pain(LBP). One of the greatest difficulties is making an accurate diagnosis, which can dictate treatment. Low back pain is common and often recurs. The lifetime prevalence ranges from 70% to 90%, with a 18% annual incidence,. LBP is second only to the common cold as a cause for primary care office visits, and direct medical costs exceed $16-$50 billion per year . Recent longitudinal studies suggest that back pain is typically recurrent and that chronic back pain occurs more frequently than previously believed . The causes of LBP in active people are diverse, and identification of the precise anatomic site of lumbar injury and pain generation is often difficult. Primary care providers frequently diagnose lumbar strain or sprain and mechanical LBP in patients without clear neurologic or complicating features. A better understanding of the natural history of LBP and the biomechanics of lumbar spine injury will assist in developing appropriate diagnosis and treatment strategies. A framework forthe evaluation and management of LBP emphasizes rehabilitation and return to activity.The basic motion segment of the spine is a three-joint complex, consisting of one intervertebral disk between adjacent vertebrae and two zygapophyseal (facet) joints. The intervertebral disk is composed of the central nucleus pulposus and the peripheral annulus fibrosis. The individual lumbar nerve roots exit bilaterally below the pedicle of each vertebra. Stability of the three-joint complex depends on the integrity of the intervertebral disks. Disk degeneration transfers weight-bearing and rotational loads to the facet joints and may produce facet joint inflammation, arthropathy, and a degenerative cascade in the lumbar spine.In the spine, the pain receptors are located in the outer one third of the intervertebral disk, the facet joint capsule, the anterior and posterior longitudinal ligaments, and the musculoligamentous supporting structures of the lumbar spine . Back pain, however, cannot be thought of as purely an anatomic or biomedical problem. Psychological factors also play a significant role in the onset of back pain and the transition from acute to chronic pain and disability. Depression, anxiety, distress, and cognitive factors have been closely linked to pain and disability.We have categorized discogenic pain into three distinct diagnostic categories: internal disc disruption(IDD), degenerative discdiseases(DDD), and segmental instability.In most cases, causes for chronic low back pain cannot be found usingconventional investigations, such as radiography and magnetic resonance imaging (MRI), with fewer than 10% of cases diagnosed by these means. Degenerative changes and conditions are not valid diagnoses of the cause of pain, as they are no more common in patients with pain than in asymptomatic individuals. However, the sources and causes of chronic lowback pain can be established if we can use Provocative computed tomography (CT) discography . The CT discography can be used to diagnose discogenic pain. The internal disc disruption is characterised by radial and circumferential fissures in the anulus fibrosus of the affected disc, in association with a degraded nuclear matrix; externally the disc is intact. This condition is not related to degeneration or age changes, but appears to be caused by fatigue failure of the vertebral endplate after repeated loading. If investigations are limited to CT or MRI, patients with chronic-low back pain cannot be diagnosed, but a diagnosis becomes possible if diagnostic discography are used.Part OneComparison of CT-Discography and MRI in the Diagnosis of Discogenic low back painBackground: Evaluation of discogenic low back pain can be difficult if gross changes are not evident on roentgenograms of computed tomographic scans. Until recently, the discogram has been the best and most definitive method for identifying discogenic low back pain .Although this procedure has b...
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