Discogenic Back Pain

Description

Intervertebral disks are a common cause of spine pain. Pain arises as the physical and chemical properties of the disks gradually deteriorate. Discogenic back pain is a broad classification referring to spine pain in which the source is the intervertebral disk. However, this classification typically does not include herniated disks.

Causes

  • Chemical or mechanical damage of intervertebral disks from wear and tear associated with age and trauma
  • Proinflammatory mediators/cytokines produced in the nucleus pulposus of the intervertebral disk that potentiate pain

Symptoms

Symptoms can vary but usually consist of chronic lower back pain often radiating to the buttock and leg. The pain can occur on one or both sides. Patients with discogenic back pain often experience intolerance to sitting for prolonged periods of time. Sneezing and coughing can also increase pain.

Diagnosis

The diagnosis begins with a history and physical exam. X-rays and CT scans often show disk space narrowing, vacuum disks, end plate sclerosis and osteophytes or bone spurs. MRIs is the favored diagnostic imaging modality as it highlights soft tissue abnormalities better. Discography can be used to correlate MRI findings with symptoms.

Management

Mild cases can be treated with over-the-counter pain medications like nonsteroidal anti-inflammatories i.e. ibuprofen. Physical therapy can help strengthen the muscles of the back, resulting in more even weight distribution. This helps to alleviate pressure on the disks. Interventional pain management injections can help alleviate more moderate to severe symptoms. Surgery is reserved for rare cases that do not resolve through such measures and procedures.