Degenerative disc disease may cause debilitating low back pain. This can lead to lost time from work, the need for narcotic pain medication, along with a tough time playing with your kids. If you have significant low back pain from degenerative disc disease, how is it diagnosed by a doctor?
When you first go to see a pain management doctor about low back pain, there are a series of questions that will be posed to try and delineate whether or not the pain is coming from a degenerative disc. Often times patients will have significant pain while sitting, as studies have actually shown the greatest pressure on the disk space is in a sitting position. Pain from a degenerative disc often waxes and wanes, so if pain is present all the time and wakes a person up at night, then there may actually be something more serious that should be evaluated more intensely.
X-rays of the low back in a degenerative disc disease situation will show a loss of height of that disk space. Because the disc is 80% water in a normal situation, you can actually see the disc itself on an x-ray. What you see is a space where the disc is, and that the disc is degenerated and has lost height that's what shows up on an x-ray. So it is an inference that a patient has degenerative disc disease on x-ray from this loss of height.
MRI can show degeneration very nicely. The T-2 images on MRI will show a black area with a degenerative disc, as when the water leaves the disk space it will turn that area on the MRI black. This is why degenerative disc disease is sometimes referred to as black disc disease. Another thing that can be seen on MRI is a tear in the outer part of the disk. This may be referred to is a high-intensity zone and can indicate a reason for why the patient has such severe low back pain.
A CAT scan is usually not indicated in a patient with degenerative disc disease. It is great at showing bone quality, but doesn't help dramatically with the disc soft tissue. It often is done however, after a procedure called a discogram. If the patient has degenerative disc disease and surgery is being considered for it, then a discogram is a procedure that can tell whether or not the disc problem is causing the patient's pain. A discogram is not a procedure for pain relief, it is only done for diagnostic purposes.
It is a heavily debated procedure, and here is how it works. The patient is sedated for a procedure by a pain management doctor. With proper numbing, a needle is placed into the disk space and fluid is injected under pressure. The patient is then asked whether or not the pain from this fluid is similar to the pain they have on a daily basis.
If the answer is yes, then that is a positive level discogram. The physician can be reasonably assured that the disc is the culprit for the low back pain. In addition to doing the one level under concern, the pain doctor will also inject another level that is not of concern as a control level to make sure the patient says it does not cause the same type of pain experienced on a daily basis.
Once the discogram is completed, a CAT scan will often be obtained immediately afterwards as the dye was injected in the discogram can show whether the dye stays in the disk, or leaks outside the disk. If the disk has tears in it and is incompetent from the degeneration, the dye will leak outside the disk and the CAT scan will show that very nicely.
These are the studies right now that exists to define the existence of degenerative disc disease and the severity. Hopefully in the future something better will come along so the definitiveness of the diagnosis will be improved.
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