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 non steroidal anti inflammatory drugs, physical therapy, rehabilitation, antidepressants, anti epileptics, 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 electro thermal therapy may offer some pain relief for a group of well-selected patients. No benefits have been found for the intradiscal radiofrequency thermo coagulation. In this presentation, I will discuss about L2 spinal nerve block as this may interfere with the transition of painful information from the discs to the central nervous system. Furthermore, I will discuss disc cell transplantation which is in the experimental stage and has the potential to become a useful option for the prevention and treatment of discogenic back pain. However, more basic science and clinical studies are needed to establish its clinical value.

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