Vertebrogenic Pain: A Paradigm Shift in Diagnosis and Treatment of Axial Low Back Pain

Conger, Aaron; Smuck, Matthew; Truumees, Eeric; Lotz, Jeffrey C.; DePalma, Michael J.; McCormick, Zachary L

doi:10.1093/pm/pnac081

Cited by 19 publications

(22 citation statements)

References 107 publications

(92 reference statements)

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“…Several interventional modalities can be used in cases unresponsive to conservative treatment, such as lumbar spine fusion surgery of the vertebral endplates, block of rami communicans on each side of the gray ramus, infusion of tumor blockade necrosis factor-alpha (TNF-α) and vertebroplasty percutaneous fluoroscopy. 20,21…”

Section: Discussionmentioning

confidence: 99%

Ablation of Rami Communicans in Patients with Symptomatic Schmorl's Nodes: A Case Report

Widyastuti

2022

JACR

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Introduction: Schmorl's node is a herniation or extrusion of an intervertebral disc nucleus into the end plate of an adjacent vertebral body. This case study aims to report a patient with symptoms of axial pain followed by MRI overview that supports the clinical symptoms. Presentation case: A man, 36 years old, working as a soldier, came to the hospital with complaints of low back pain. The patient is referred by an orthopedic doctor. The patient complained of lower back pain 2 years ago. Initially, the pain was intermittent, but in recent months it has been continuous. The pain gets worse when the patient gets out of bed, moves, and performs movements such as bowing, breathing, and coughing. The pain subsides when the patient is in a lying position. Physical examination showed pain intensity based on a visual analogue scale (VAS) 8-9/10. Examination of the extremities showed 5/6 motor strength in all extremities. Facet loading test: positive extension, forward bending (+). Anteroposterior/lateral lumbosacral X-ray examination showed no abnormalities. MRI examination showed degenerative disc disease and Schmorl's nodes corpus VL 1-2-4-5 (Figure 1). The patient was diagnosed with chronic discogenic et causa Schmorl’s node pain. Conclusion: Ablation of rami communicans is useful in the management of Schmorl's node pain.

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Section: Discussionmentioning

confidence: 99%

Ablation of Rami Communicans in Patients with Symptomatic Schmorl's Nodes: A Case Report

Widyastuti

2022

JACR

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“…Besides conservative treatment, the most common currently available treatment for degenerative disc disease remains operative[ 96 - 99 ]. This includes various procedures such as discectomy, spinal fusion, disc arthroplasty and epidural steroid injections.…”

Section: Glance At the Treatment Of The Degenerative Disc Diseasementioning

confidence: 99%

Endplate role in the degenerative disc disease: A brief review

Velnar¹,

Gradišnik²

2023

World J Clin Cases

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The degenerative disease of the intervertebral disc is nowadays an important health problem, which has still not been understood and solved adequately. The vertebral endplate is regarded as one of the vital elements in the structure of the intervertebral disc. Its constituent cells, the chondrocytes in the endplate, may also be involved in the process of the intervertebral disc degeneration and their role is central both under physiological and pathological conditions. They main functions include a role in homeostasis of the extracellular environment of the intervertebral disc, metabolic support and nutrition of the discal nucleus and annulus beneath and the preservation of the extracellular matrix. Therefore, it is understandable that the cells in the endplate have been in the centre of research from several viewpoints, such as development, degeneration and growth, reparation and remodelling, as well as treatment strategies. In this article, we briefly review the importance of vertebral endplate, which are often overlooked, in the intervertebral disc degeneration.

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“…Indeed, it has recently been suggested that Interleukin‐8 in the cerebrospinal fluid differentiates patients with chronic LBP and degenerative disc disease from asymptomatic individuals with degenerative disc disease (Krock et al., 2019). There is also growing evidence that the vertebra can be a nociceptive source of degenerative LBP (‘vertebrogenic LBP’) (Conger et al., 2022): Modic changes, that is, a certain type of MRI signal intensity changes in the vertebral endplates in conjunction with degeneration of the adjacent intervertebral disc (Modic et al., 1988), are associated with NSLBP (Brinjikji et al., 2015; Jensen et al., 2008). Modic changes might be caused by inflammatory processes (repetitive mechanical stress to the discs and vertebras) (Conger et al., 2022), but an infective origin by anaerobic bacteria is also discussed (Albert, Lambert, et al., 2013).…”

Section: What Is Non‐specific Low Back Pain?mentioning

confidence: 99%

“…There is also growing evidence that the vertebra can be a nociceptive source of degenerative LBP (‘vertebrogenic LBP’) (Conger et al., 2022): Modic changes, that is, a certain type of MRI signal intensity changes in the vertebral endplates in conjunction with degeneration of the adjacent intervertebral disc (Modic et al., 1988), are associated with NSLBP (Brinjikji et al., 2015; Jensen et al., 2008). Modic changes might be caused by inflammatory processes (repetitive mechanical stress to the discs and vertebras) (Conger et al., 2022), but an infective origin by anaerobic bacteria is also discussed (Albert, Lambert, et al., 2013). However, current results of clinical studies treating LBP associated with Modic changes (type 1 (Albert, Sorensen, et al., 2013) and type 1 or type 2 (Braten et al., 2019), respectively) with antibiotics are controversial (Gilligan et al., 2021).…”

Section: What Is Non‐specific Low Back Pain?mentioning

confidence: 99%

“…However, current results of clinical studies treating LBP associated with Modic changes (type 1 (Albert, Sorensen, et al., 2013) and type 1 or type 2 (Braten et al., 2019), respectively) with antibiotics are controversial (Gilligan et al., 2021). Relatively recently, the basisvertebral nerve, a branch of the sinusvertebral nerve, has been identified as being a candidate for transmitting nociceptive information from the endplate (Conger et al., 2022). In line with this notion, the ablation of the basisvertebral nerve has been reported to significantly reduce pain and disability in patients with chronic LBP associated with Modic changes (type 1 or 2) after 3 months (Fischgrund et al., 2018; Khalil et al., 2019) and also long term (Fischgrund et al., 2018, 2020).…”

Section: What Is Non‐specific Low Back Pain?mentioning

confidence: 99%

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Personalized assessment and management of non‐specific low back pain

Wirth,

Schweinhardt

2023

European Journal of Pain

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Background and ObjectiveLow back pain (LBP), and in particular non‐specific low back pain (NSLBP), which accounts for approximately 90% of LBP, is the leading cause of years lived with disability worldwide. In clinical trials, LBP is often poorly categorized into ‘specific’ versus ‘non‐specific’ and ‘acute’ versus ‘chronic’ pain. However, a better understanding of the underlying pain mechanisms might improve study results and reduce the number of NSLBP patients.Databases and Data TreatmentNarrative review.ResultsNSLBP is a multi‐dimensional, biopsychosocial condition that requires all contributing dimensions to be assessed and prioritized. Thereby, the assessment of the contribution of nociceptive, neuropathic and nociplastic pain mechanisms forms the basis for personalized management. In addition, psychosocial (e.g. anxiety, catastrophizing) and contextual factors (e.g. work situation) as well as comorbidities need to be assessed and individually weighted. Personalized treatment of NSLBP further requires individually choosing treatment modalities, for example, exercising, patient education, cognitive‐behavioural advice, pharmacotherapy, as well as tailoring treatment within these modalities, for example, the delivery of tailored psychological interventions or exercise programs. As the main pain mechanism and psychosocial factors may vary over time, re‐assessment is necessary and treatment success should ideally be assessed quantitatively and qualitatively.ConclusionsThe identification of the main contributing pain mechanism and the integration of the patients' view on their condition, including beliefs, preferences, concerns and expectations, are key in the personalized clinical management of NSLBP. In research, particular importance should be placed on accurate characterization of patients and on including outcomes relevant to the individual patient.Significance StatementHere, a comprehensive review of the challenges associated with the diagnostic label ‘non‐specific low back pain’ is given. It outlines what is lacking in current treatment guidelines and it is summarized what is currently known with respect to individual phenotyping. It becomes clear that more research on clinically meaningful subgroups is needed to best tailor treatment approaches.

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Vertebrogenic Pain: A Paradigm Shift in Diagnosis and Treatment of Axial Low Back Pain

Cited by 19 publications

References 107 publications

Ablation of Rami Communicans in Patients with Symptomatic Schmorl's Nodes: A Case Report

Ablation of Rami Communicans in Patients with Symptomatic Schmorl's Nodes: A Case Report

Endplate role in the degenerative disc disease: A brief review

Personalized assessment and management of non‐specific low back pain

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