The relative contributions of the disc and zygapophyseal joint in chronic low back pain. AUTHOR: Schwarzer AC; Aprill CN; Derby R; Fortin J; Kine G; Bogduk N AUTHOR AFFILIATION: Faculty of Medicine, University of Newcastle, Australia. SOURCE: Spine 1994 Apr 1;19(7):801-6 CITATION IDS: PMID: 8202798 UI: 94261924 ABSTRACT: STUDY DESIGN. A prospective cross-sectional analytic approach was taken. OBJECTIVES. This study sought to determine the relative contribution of the disc and the zygapophyseal joint as a pain source in patients with chronic low back pain. SUMMARY OF BACKGROUND DATA. Previous studies have employed either zygapophyseal joint blocks or discography, but in no studies have both procedures been performed. METHODS. Ninety-two consecutive patients with chronic low back pain were studied using both discography and blocks of the zygapophyseal joints. RESULTS. Thirty-six patients (39%) had at least one positive discogram as defined by exact pain reproduction, an abnormal image, and a negative control. Eight patients responded to both a screening zygapophyseal joint block using lignocaine and a confirmatory block using bupivacaine. Only three patients had both a positive discogram and a symptomatic zygapophyseal joint. CONCLUSIONS. In patients with chronic low back pain, the combination of discogenic pain and zygapophyseal joint pain is uncommon. MAIN MESH HEADINGS: Intervertebral Disk Displacement/*complications Low Back Pain/*etiology *Lumbar Vertebrae ADDITIONAL MESH HEADINGS: Adult Bupivacaine/diagnostic use Female Human Intervertebral Disk/radiography Intervertebral Disk Displacement/diagnosis Lidocaine/diagnostic use Male Spinal Diseases/complications Spinal Diseases/diagnosis Support, Non-U.S. Gov't PUBLICATION TYPES: JOURNAL ARTICLE REGISTRY NUMBERS: 137-58-6 (Lidocaine) 2180-92-9 (Bupivacaine) LANGUAGE: Eng