14. Discogenic Low Back Pain

Discogenic low back pain can be severely disabling, clinically challenging to diagnose, and expensive to treat. Disc degeneration is characterized by disc dehydration, which diminishes the ability of the disc to distribute pressure, making it more susceptible to damage, and leading to annular tears, fissures, and a higher incidence of herniation. Furthermore, the abnormal annular in-growth of nerves and inflammation of the disc increase the number and sensitivity of nociceptors, leading to chronic discogenic low back pain (CDLBP). The purpose of this article was to review the current literature.

In this narrative review, the literature on the diagnosis and treatment of discogenic low back pain was summarized.

Symptoms and findings during physical examination may guide the diagnostic process but are not specific or sensitive regarding CDLBP. Magnetic resonance imaging (MRI) can rule out other pathology and provides a basis for the decision about whether to perform pressure-controlled provocative discography, the current diagnostic standard. Conservative care includes pain education programs, structured exercise therapies, psychological interventions, and pharmacological treatment. Various minimally invasive interventional treatment strategies for refractory CDLBP exist, of which biacuplasty or cooled radiofrequency can be used as therapeutic options. Promising new treatments include intradiscal injection of mesenchymal stem cells and platelet-rich plasma, radiofrequency ablation of the sinuvertebral and basivertebral nerves, dorsal root ganglion stimulation, and spinal cord stimulation. Future research regarding the safety and efficacy of these treatments should include large randomized controlled trials with strict inclusion criteria and longer follow-up periods. A primary focus should be on increasing the evidence base for diagnosing discogenic low back pain.