Chelala L, et al. - Lumbar spine discography records and prediscography magnetic resonance imaging (MRIs) of 736 subjects (2,457 discs) who underwent discography for diagnostic purposes from 2003 to 2007 were retrospectively analyzed by the researchers in an Institutional Review Board–exempt and Health Insurance Portability and Accountability Act-compliant protocol, in order to estimate the positive predictive value (PPV) of lumbar spine MRI findings for a painful disc using provocative discography. Each level was recognized as having a high-intensity zone (HIZ) disc, disc protrusion, disc extrusion, or combination (any herniation type), disc bulge, disc degeneration, and spondylolisthesis. For a provocative discography, an HIZ disc had a PPV of 0.71. A disc protrusion, a disc extrusion had a PPV of 0.79 and 0.93, respectively, and latter a bulge of 0.43, and a degenerative disc of 0.32. A spondylolisthesis had a PPV of 0.67. A PPV of 0.80 of herniation of either type (extrusion or protrusion) was noted. Hence, in order to recognize a pain generator, disc herniations and HIZ discs had high predictive value. Moreover, for discogenic pain, an extruded disc herniation had the maximum PPV.