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Peer-reviewedCC BY-NC-ND 4.0Interventional Pain Medicine

Anterior annular disruption presenting as hip pain: A case report of iliopsoas contrast extravasation during lumbar discography

  • Waleed Sultan1
  • Jay Napolitano1
  • Reny Morales1
  • Fred DeFrancesch1
  1. 1Interventional Spine Specialists, Metairie, LA, USA
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Abstract

Background: Discogenic pain may present with atypical referral patterns that mimic primary hip pathology, creating diagnostic challenges when conventional imaging findings are inconclusive. Provocative discography remains one of the few diagnostic procedures capable of correlating structural disc abnormalities with concordant pain symptom reproduction.

Case presentation: A 79-year-old woman with chronic low back pain, severe left anterior hip and groin pain, and lumbar degenerative disc disease without Modic endplate changes underwent lumbar discography after failure of conservative and interventional treatments. Discography demonstrated a grade V (Dallas Modified Discogram Scale) annular tear at L4–5 with contrast extravasation anteriorly into the iliopsoas compartment, reproducing the patient's characteristic hip pain. Following intradiscal steroid administration, the patient reported approximately 50% overall pain reduction. Serial follow-up fluoroscopic imaging obtained at repeat therapeutic intradiscal steroid administration (6 months, 9 months, and approximately 3 years) demonstrated progressive reduction in anterior contrast propagation, resolution of the iliopsoas communication, and improved pain as well as eventual resolution of the grade V annular tear and intradiscal contrast containment.

Conclusion: This case illustrates an unusual presentation of discogenic pain in which anterior annular disruption with extension into the iliopsoas compartment reproduced concordant hip pain and mimicked primary hip pathology. Long-term imaging demonstrated interval stabilization of the annular defect following serial intradiscal steroid therapy, providing a unique radiographic correlation between symptomatic annular disruption, referred hip pain, and clinical response.

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Cite

BibTeXRIS
BibTeX
@article{sultan2026anterior,
  title = {{Anterior annular disruption presenting as hip pain: A case report of iliopsoas contrast extravasation during lumbar discography}},
  author = {Waleed Sultan and Jay Napolitano and Reny Morales and Fred DeFrancesch},
  journal = {Interventional Pain Medicine},
  year = {2026},
  month = oct,
  doi = {10.1016/j.inpm.2026.100831},
  url = {https://doi.org/10.1016/j.inpm.2026.100831},
  note = {CC BY-NC-ND 4.0},
}
RIS
TY  - JOUR
TI  - Anterior annular disruption presenting as hip pain: A case report of iliopsoas contrast extravasation during lumbar discography
AU  - Waleed Sultan
AU  - Jay Napolitano
AU  - Reny Morales
AU  - Fred DeFrancesch
PY  - 2026
DA  - 2026/10/27
JO  - Interventional Pain Medicine
DO  - 10.1016/j.inpm.2026.100831
UR  - https://doi.org/10.1016/j.inpm.2026.100831
AB  - Background: Discogenic pain may present with atypical referral patterns that mimic primary hip pathology, creating diagnostic challenges when conventional imaging findings are inconclusive. Provocative discography remains one of the few diagnostic procedures capable of correlating structural disc abnormalities with concordant pain symptom reproduction.  Case presentation: A 79-year-old woman with chronic low back pain, severe left anterior hip and groin pain, and lumbar degenerative disc disease without Modic endplate changes underwent lumbar discography after failure of conservative and interventional treatments. Discography demonstrated a grade V (Dallas Modified Discogram Scale) annular tear at L4–5 with contrast extravasation anteriorly into the iliopsoas compartment, reproducing the patient's characteristic hip pain. Following intradiscal steroid administration, the patient reported approximately 50% overall pain reduction. Serial follow-up fluoroscopic imaging obtained at repeat therapeutic intradiscal steroid administration (6 months, 9 months, and approximately 3 years) demonstrated progressive reduction in anterior contrast propagation, resolution of the iliopsoas communication, and improved pain as well as eventual resolution of the grade V annular tear and intradiscal contrast containment.  Conclusion: This case illustrates an unusual presentation of discogenic pain in which anterior annular disruption with extension into the iliopsoas compartment reproduced concordant hip pain and mimicked primary hip pathology. Long-term imaging demonstrated interval stabilization of the annular defect following serial intradiscal steroid therapy, providing a unique radiographic correlation between symptomatic annular disruption, referred hip pain, and clinical response.
SN  - 2772-5944
ER  -