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KMID : 0614520070170010011
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Journal of the Korean Pain Research Society
2007 Volume.17 No. 1 p.11 ~ p.17
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Diagnosis and Treatment of Discogenic Low Back Pain
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Chough Chung-Kee
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Abstract
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Diagnosis and treatment of discogenic low back pain is a challenge. It account for 40% of patients with low back pain. The mechanism of discogenic pain is unclear and its clinical picture is atypical. Magnetic resonance imaging (MRI) can find high-intensity zone as an indirect indication of Internal disc disruption (IDD) and Modic endplate signal change as a sign of degenerative disc disease (DDD). However, relative low sensitivity and high false-positive and false-negative rates reduce the value of MRI in screening for the discogenic pain. Provocative discography can provide unique information about the pain source and the morphology of the disc. It may also provide information for selecting appropriate treatment for the painful annular tear. Adjunctive therapies, including nonsteroidal anti-inflammatory drugs, physical therapy, rehabilitation, antidepressants, antiepileptics, and acupuncture, have been used for low back pain. The value of these treatments for discogenic pain is yet to be established. Intradiscal electrothermal therapy may offer some pain relief for a group of well-selected patients. The surgical treatment of intractable discogenic low back pain has been spinal fusion. But, fusion is not generally accepted as gold standard for treatment of unremitting discogenic low back pain. Dynamic spinal stabilization and disc arthroplasty are newly developed alternative surgical options that may prevent adjacent disc degeneration which is one of the major concerns in spinal fusion. However clinical efficacies and long term results of these treatments are yet to be established. Disc cell transplantation is in the experimental stage. It has the potential to become a useful tool for the prevention and treatment of discogenic pain. More basic science and clinical studies are needed to improve the clinical efficacy of treatments of discogenic low back pain.
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KEYWORD
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Discogenic, Lumbar, Diagnosis, Treatment
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