LOW BACK - DISK PAIN (LUMBAR DISCOGENIC PAIN)
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What is Discogenic Back Pain?
Discogenic back pain is caused by irritation of a vertebral disk. The disk has nerve fibers. Over time, degeneration of the disk and the spine leads to irritation of these nerve fibers and this causes pain localized to the back.
A disk lives between each of the vertebrae and acts as a squishy shock absorber and enables motion between your vertebrae (this is what allows you to twist at your hips…if the vertebrae were just one long bone you would be as inflexible as a lead pipe). Each disk is named after the two vertebrae that it sits between. For example the disk at L4-L5 sits between the 4th and 5th lumbar vertebrae.
How is Discogenic Back Pain diagnosed?
There are many causes of low back pain. Compression of a spinal nerve due to a herniated disk and arthritis in the spine (aka spinal stenosis) are all common reasons. If no other cause can be identified, doctors suspect that it may be from irritation of the vertebral disk itself.
Discogenic pain will present as low back pain without any pain that radiates down the leg (in contrast to lumbar stenosis or a disk herniation where the pain travels with the pinched nerve down the leg). The straight leg test (which places a spinal nerve on tension) will not lead to worsening pain because its not the nerve causing the pain but rather sensory fibers within the disk itself.
Sometimes a test called a “Provocative Diskogram” is used, where dye is injected into the disk and x-rays or a CT scan is taken. If there are signs of severe degeneration seen then the test is positive. The problem with this test is that its invasive ("painful") because you put a needle into someones back, and this may actually speed up degeneration of the disks.
How is Discogenic Back Pain treated?
Nonsurgical treatment with anti-inflammatories and physical therapy (specifically core strengthening) are recommended. The core strengthening makes stronger muscles that take pressure off the painful disk.
If conservative methods fail, then surgery can be performed to remove the disk that’s very inflamed. If the disk is removed, then the two vertebrae must be fused (jointed).
What is the long term outcome?
The long term results for treatment of this issue are still coming in.