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[The pathogenesis of discogenic low back pain]
Bao-Gan Peng1, Wen-Wen Wu, Shu-Xun Hou
1Department of Orthopaedics, the 304th Hospital of People's Liberation Army, Beijing 100037, China.
Zhonghua Wai Ke Za Zhi [Chinese Journal of Surgery]
|August 27, 2004
Summary
The strip zone of granulation tissue with extensive innervation in painful discs is the source of discogenic low back pain. This tissue may arise from annulus fibrosus injury and repair, differentiating painful from aging discs on MRI.
Area of Science:
- Spinal pathology
- Pain mechanisms
- Histopathology
Context:
- Discogenic low back pain is a significant clinical challenge.
- Understanding pain pathogenesis is crucial for effective treatment.
- Discography is used to diagnose the source of back pain.
Purpose:
- To investigate the pathogenesis of pain in discography and discogenic low back pain.
- To compare the morphology and innervation of painful, aging, and normal lumbar intervertebral discs.
Summary:
- Painful discs exhibit a distinct "strip zone" of vascularized granulation tissue with fissures, extending from the nucleus pulposus to the annulus fibrosus.
- This granulation tissue zone shows significantly more innervation with substance P (SP), neural filament (NF), and vasoactive-intestinal peptide (VIP) compared to aging or normal discs.
- Nerve ingrowth occurs along this strip zone into the annulus fibrosus and nucleus pulposus, suggesting it as the origin of pain.
Impact:
- Identifies the "strip zone" of granulation tissue and its extensive innervation as the primary site of pain in discogenic low back pain.
- Suggests this histological feature, originating from annulus fibrosus injury and repair, differentiates painful discs from aging discs that appear similar on MRI.
- Provides a histopathological basis for understanding discogenic pain, potentially guiding future diagnostic and therapeutic strategies.