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What is Discogenic Low Back Pain?
by Samantha Kanarek, DO, Reconstructive Orthopedics
The intervertebral disc is a structure that lies between two
vertebrae in the spine. It has a circular shape with two
parts, outer layers of fibrous rings (annulus fibrosis)
surrounding a center filled with a gelatinous substance
(nucleus pulposus). The disc is designed to promote
normal motion of the spine and provide cushioning.
Younger people tend to have more robust discs. As we
age, the discs can dry out and wear down, resulting in
decreased disc height and possible bulges. Changes in
disc height and bulges do not necessarily cause pain, but
if the outer layers of the disc tear, also known as an
“annular tear,” this can result in low back pain.
“Discogenic Low Back Pain” is low back pain resulting from
injury to the disc. The annular tear of the disc may or may
not be visualized on MRI of the spine. The majority of
patients affected by this are younger to middle aged adults,
and once older age hits, the disc may wear down to the
point where it is no longer painful.
Pain related to a disc tear differs from pain related to a
“herniated disc.” A herniated disc results when a portion of
the central gelatinous material protrudes or extrudes out
of the outer layers of the disc. This gelatinous material can
irritate the adjacent nerve root, resulting in pain. Pain
related to a disc herniation rarely causes low back pain,
and most often causes buttock and leg pain. On the
contrary, disc pain from an annular tear tends to cause
low back pain that does not radiate to the buttock or leg.
The pain is vague and difficult to localize. The pain tends
to be worse with sitting, bending over to put on your shoes
and socks, and at times may be worse with activities that
increase intra-abdominal pressure (laughing, coughing,
sneezing, bowel movements).
If you, a family member, or a friend is suffering from “Disc
Pain,” I recommend evaluation by a physician who
specializes in managing conditions of the spine or
back. The most important way to diagnosis this
condition is by history and physical exam. X-ray
and MRI are often not necessary, but may be
ordered to evaluate for other possible conditions.
The most effective treatment for “Discogenic Low
Back Pain” is physical therapy emphasizing on
lumbar and core strengthening. The goal is to build
up the surrounding muscles to provide “scaffolding” that can reduce stress on the disc. Learning
proper lifting and postural mechanics is essential.
Over the years, numerous spinal procedures have been
developed with the goal of reducing pain, including
epidural injections, burning the disc, injecting cement
into the disc, and replacing the disc by fusing the spine.
Unfortunately, there is no good evidence that any of these
procedures provide good long-term relief for this type
of low back pain.
Despite the challenges in managing this condition, patients
can still be treated effectively and maintain a high level of
functioning.
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Reconstructive Orthopedics, you won’t have to wonder who will be performing your procedure. Very early in the process, you’ll meet
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