Diagnosis and Minimally Invasive Treatment of Lumbar Discogenic Pain – A Review of the Literature

Abstract

Diagnosis and treatment of lumbar discogenic pain due to internal disc disruption (IDD) remains a challenge. It accounts for 39% of patients with low back pain. The mechanism of discogenic pain remains unclear and its clinical presentation is atypical. Magnetic resonance imaging (MRI) can find high-intensity zone as an indirect indication of IDD. However, relative low sensitivity (26.7% to 59%) and high false-positive (24%) and false-negative (38%) rates reduce the value of MRI in screening for the existence of painful IDD. 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 steroid injection has not been proved to provide long-term benefits. Intradiscal electrothermal therapy may offer some pain relief for a group of well-selected patients. No benefits have been found for the intradiscal radiofrequency thermocoagulation. A block in the ramus communicans may interfere with the transition of painful information from the discs to the central nervous system. 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. Minimally invasive treatments provide alternatives for discogenic pain with the appeal of cost-effectiveness and, possibly, less long-term side effects. However, the value of most of these therapies is yet to be established. More basic science and clinical studies are needed to improve the clinical efficacy of minimally invasive treatments.

Surgical Outcome and Postoperative Work Status of Lumbar Discogenic Pain Following Transforaminal Interbody Fusion

“…Diagnosis of lumbar discogenic pain remains challenging and no unified diagnostic criteria exists. 26) Conventionally, discography is a reliable examination available for the diagnosis of discogenic pain. On the other hand, some authors had little confidence in discography and the positive predictive value of discography was calculated to be 50% to 60%.…”

Randomized sham‐controlled, double‐blind, multicenter clinical trial on the effect of percutaneous radiofrequency at the ramus communicans for lumbar disc pain

“…Interrupting signalling through the ramus communicans may interfere with the transition of painful information from the discs to the central nervous system (Zhou and Abdi, 2006). To evaluate the efficacy of a RF treatment at the ramus communicans, a few studies were performed (Oh and Shim, 2004; Levin, 2009).…”

Application of Radiofrequency in Low Back Pain Treatment

“…Moreover, MRI also provides adjacent vertebrae end plate signal change and annular tear which is thought to be strongly associated with disogenic LBP (Carragee & Hannibal 2004;Zhou & Abdi 2006).…”