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

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.