Discogenic Low Back Pain

Written by Praveen V. Mummaneni, MD

Low back pain is a common condition, can be caused by lumbar sprain, spinal stenosis, disc herniation, and different degenerative spinal disorders. The topic of today's discussion is discogenic low back pain; a degenerative condition. The term discogenic pain means one or more intervertebral discs are the pain source.
Symptoms of Discogenic Low Back Pain
As we age, our bodies undergo many changes. For example, our hair may begin to turn gray or thin. Similar gradual changes affect the spine's structures, notably the intervertebral discs. Early disc degeneration may not cause severe pain or other symptoms, but when the degeneration becomes advanced low back pain may occur.

Typically, discogenic pain is associated with activities that increase the pressure within the intervertebral disc (called intradiscal pressure).

How Discs Cause Pain
Just like other parts of the body, each intervertebral disc has a nerve supply. Discs are comprised of two parts; the annulus fibrosus (outer ring-like structure) and nucleus pulposus (gel-like interior). The nucleus pulposus is void of nerves. However, the outer third of the annulus fibrosus contains nerve fibers.

One type of discogenic disorder is called an Internal Disc Disruption (IDD). An IDD occurs when the disc tears or cracks (fissure) allowing the nucleus pulposus to meet the annulus fibrosus. When this happens, a chemical called a protecogylcan may be released from the nucleus pulposus. Protecoglycans may irritate the annular nerves causing an inflammatory response and pain. For unknown reasons, some people have annular tears and yet are symptom free!

Diagnosing Low Back Discogenic Pain
Degenerative disc changes can best be seen on magnetic resonance imaging (MRI).

If one or more spinal discs are suspected as the pain source, the doctor may order a provocative discogram or discography. During this sterile procedure, the suspect discs are injected with a contrast dye to make each disc visible under fluoroscopy. Provocative discography helps the doctor to see the shape and size of the intervertebral disc. The injection of the contrast dye alters the pressure within the disc and may 'provoke' or reproduce the patient's pain pattern; thereby helping to isolate a particular disc as a pain generator.

Non-Surgical Treatments
There are many different types of treatment to help relieve low back and leg pain. Often, treatments are combined for better symptom control or relief.

Minimally Invasive Procedures
Many different spine surgical procedures can be performed using minimally invasive techniques. For example, spine surgeons use such techniques to treat herniated discs, correct scoliosis, and perform spinal fusion. The benefits to the patient are enormous and include smaller incisions, shorter time hospitalized, less post-operative pain, and a speedier recovery. Spinal fusions may alleviate disc related back pain by replacing the disc with bone and cages. Artificial cervical and lumbar discs have become another option to replace damaged discs.

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