Does a Fibronectin and Aggrecan Complex Play a Role in Painful Vertebral Disks?

ObjectiveTo determine the presence of a fibronectin-aggrecan complex (FAC) in the disk space of persons with chronic low back pain as relates to provocative diskography.DesignA single-center prospective consecutive case series.SettingA single private practice setting.PatientsThirty-seven patients with symptomatic degenerative disk disease of the cervical, thoracic, or lumbar spine undergoing provocative diskography to identify a source of pain.MethodsDiskographic lavage for analysis was simultaneously performed at each disk level injected during diskography.Main Outcome MeasuresVisual analog scale (VAS) pain scores, Pfirrmann magnetic resonance imaging grade, and biochemical analysis of disk material were statistically analyzed.ResultsA total of 105 levels in 37 patients had a complete set of data (mean age 43.2 ± 11.9 years; 15 male/22 female). The FAC was present in 43 of 108 levels and in at least one level in 25 of 37 patients. The Pfirrmann magnetic resonance imaging grade did not differ between complex-positive and negative levels (P = .125), nor did the intraoperative VAS (IO-VAS) score for pain by level (P = .206). A significant but loose correlation was found between Pfirrmann grade and IO-VAS (R2 = 0.4, P < .001), but no significant correlation was found between VAS or IO-VAS and complex concentration (R2 = 0.08, P = .11 and R2 = 0.003, P = .5).ConclusionsThe FAC was identified in some painful disks by diskography. There was no significant correlation between the Pfirrmann grade or pre/intraoperative pain scores during diskography and complex concentrations within the disk measured by disk lavage.