Spine Archive: Discogenic Back Pain

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Locations of Discogenic Pain

Primarily, discogenic pain is localized to the lumbar area of your back, also known as your lower back. Pain is most often located here because of the anatomy of the lower spine which has five vertebrae – each with soft discs in between. With age, these hydrated discs lose water content and can crack and tear. Therefore, these cracks and tears can cause pain.

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Discogenic Pain

Back pain is one of the most common medical concerns, especially in the elderly. This pain is associated with the natural aging of the spinal column and can originate in the neck and lower back. Pain resulting from damaged vertebral discs are also referred to as discogenic pain.

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Lumbar Fusion

Lumbar fusion is the surgical procedure of choice for the treatment of discogenic low back pain in patients who have intractable pain after an aggressive nonsurgical management program, MRI findings of disk degeneration, and concordant discography at one or two levels. Disk excision or other disk decompression procedures are not recommended for these patients.

¹R. Vaccaro MD, Alexander. Orthopaedic Knowledge Update. Rosemont: American Academy of Orthopaedic Surgeons, 2005.

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Discogenic Low Back Pain

Discogenic low back pain refers to pain originating from a degenerative lumbar disk, which is characterized by axial low back pain without associated radicular findings, spinal deformity, or instability. The controversy surrounding discogenic low back pain primarily exists because degenerative changes at the disks are ubiquitous, yet symptoms arise in only a few patients; multiple additional anatomic sources of low back pain is made primarily with provocative diskography.¹

¹R. Vaccaro MD, Alexander. Orthopaedic Knowledge Update. Rosemont: American Academy of Orthopaedic Surgeons, 2005.

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Discogenic Back Pain

A multifaceted approach to nonsurgical care in the form of anti-inflammatory medications, fitness programs, weight loss, and functional rehabilitation remains the first-line treatment of discogenic back pain. For most patients with this condition, these measures are often effective in managing symptoms until the episode resolves. Other nonsurgicval measures such as acupuncture, behavioral therapy, and exercise therapy have also demonstrated modest improvement in symptoms. Althouygh multiple different physical therapy modalities have been compared, no single program has demonstrated greater efficacy over another. Transcutaneous electrical nerve stimulation, muscle stimulation protocols, traction, and chiropractic treatment have not demonstrated long-term efficacy in the management of low back pain.

When multiple modalities of nonsurgical management fail in patients diagnosed with discogenic low back pain, there are limited options for further treatment. Surgical treatment is considered a last-resort option for the patient who endures intractable symptoms for a 6-month period; however, controversy remains among experienced practitioners regarding the exact surgical indications. Lumbar fusion has historically been used in the surgical treatment of degenerative disk disease; however, reported clinical outcomes are widely variable. An individual patient’s response to surgery can be affected by association with workers’ compensation, psychosocial comorbidities, and unrealistic expectations.¹

¹Garfin MD, Steven. Orthopaedic Knowledge Update : Spine. Rosemont: American Academy of Orthopaedic Surgeons, 1997.