[Radiological and electrodiagnostic methods in the diagnosis of chronic pain syndromes: chronic low-back pain].
BACKGROUND: This review of radiological and other procedures used in the diagnosis of (chronic) low-back pain is not intended to provide a complete evaluation of the methods employed, because the validity, specificity and sensitivity of the various diagnostic measures are the subject of so much controversy that a comprehensive discussion would be beyond the scope of the present overview. The choice of method depends not only on the clinical symptoms but also on the localisation of the pain, the aetiology of which may also be related to the age of the patient. CAUSES OF PAIN: Radiculary pain is usually derived from anatomical structures around the roots of a nerve, but it may be of discogenic origin. Diagnosis is achieved by a combination of radiological and neurophysiological methods. It is far more difficult to localise the cause of chronic pseudoradiculary low-back pain, because the main pathological structures can be the intra-articular portions of the vertebral body, the vertebral body itself, the ligamenta intervertebralia or the muscles. Using osteoporosis as an example, the structures of the spine which may cause pain are discussed and the possible diagnostic methods are described. In addition to diagnostic procedures like CT or MRT, use can also be made of interventional radiological methods like discography or facet-joint injections. Such techniques can be supplemented by diagnostic tests under local anaesthesia which may be useful in helping to define the pain. Repeated use of these procedures is only justified if the character of the pain changes or the pain suddenly becomes more pronounced. An algorithm is presented as a guideline only, because a more standardised approach does not give sufficient consideration to the personal experience of the individual user.