Discogenic pain is severe lumbar pain that originates from the lumbar disc. It can be degenerative and a normal part of the aging process. It is classically known as internally disrupted disc or torn disc. A tear in the annulus (the tough outer ring of the disc) causes leakage of nucleus material which results in chemical irritation of the nerve fibers in the affected disc. The inflammatory process cause severe pain on prolonged sitting or standing. There is increased sensitivity in movement such as bending, twisting and flexion.
Diagnosis can be made by physical examination based on presentation of symptoms, but definitive diagnosis is typically made by MRI to rule out other diagnosis. However, a discogram gives detailed view of the structure of the disc in order to accurately locate the tear and reveal the source of the pain.
The treatments for Discogenic pain are both surgical and non-surgical, depending on the severity of the condition. Non-operative care includes rest for acute and mild low back pain. Anti-inflamatory such as NSAID medications are used to reduce swelling and pain while physical therapy is used to improve muscle strength in the back and reduce pressure on the spine. Other beneficial non-surgical interventions include steroidal and transforamial injections. These are considered the “gold” standard in alleviating pain associated with degenerative diseases.
Surgical intervention is referred to as fusion of the disc. It involves removal of the disrupted disc and replacement with bone graft, a cage-filled bone graft or a bone graft substitute. Fusion can be anterior, posterior or combined. Another surgical option is Arthroplasty, where a total disc replacement of the articulating disc is done. Also, Intradiscal Electrothermic Therapy is a new procedure which is minimally invasive.