LOW BACK PAIN-Disc damage

 
Discogenic low back pain is a sort of pain originating from a damaged or degenerated intervertebral disc in the spine. The intervertebral discs act as shock absorbers between the vertebrae (bones) of the spine, allowing flexibility and movement. When these discs degenerate or become damaged, they can cause pain, stiffness, and discomfort in the lower back.

Key Features of Discogenic Low Back Pain:

1. Degeneration of the Disc: Over time, the discs may lose hydration and become less flexible, leading to degeneration. This usually happens with normal aging, but can also be accelerated by injury or overuse.
2. Pain Source: Your back pain may be purely arising from discs, or it may come from muscle, nerve, or joint issues. In some cases, the pain may come from a combination of two or more different structures.
3. Symptoms:
   • Lower back pain: Typically localized and can worsen with sitting, bending, or lifting.
   • Referred pain: Pain may radiate to the buttocks, thighs, or hips but generally does not extend below the knees, unlike sciatica.
   • Stiffness: Reduced mobility, especially after periods of inactivity.
   • Aggravating activities: Activities that increase pressure on the disc, such as prolonged sitting, bending forward, or lifting heavy objects, may worsen the pain. In extreme cases, even coughing or sneezing would aggravate the pain.
4. Diagnosis:
   • Clinical evaluation: Your doctor will assess the patient’s medical history, symptoms, and physical examination findings.
   • Imaging: MRI or CT scans may reveal disc degeneration, but the correlation between disc appearance and pain is not always direct. In other words, you may have abnormalities reported in your CT scan or MRI, but the disc is not the source of pain.
   • Discography: A diagnostic test where contrast dye is injected into the disc to provoke pain and identify the specific disc causing symptoms.
5. Treatment:
   • Conservative management: Rest, physical therapy, anti-inflammatory medications, and exercises to strengthen core muscles.
   • Injections: Steroid and anesthetic injections (or what is commonly called as epidural injection) may help reduce inflammation and provide pain relief. Platelet Rich Plasma has also been shown to be an effective form of treatment. In certain situations, the interface between the disc and bone becomes inflamed. Nowadays, we have very effective forms of injection to make the pain go away.
   • Surgery: In severe cases, procedures like spinal fusion or disc replacement may be considered if conservative treatments fail to alleviate pain. However, the surgery for pure low back pain without buttock or leg pain is notoriously less effective.

How do we diagnose discogenic pain?

We will listen to your descriptions of pain, examine you, and review your MRI. In very complicated cases where you have previously received treatments but they were not effective, we may perform a test injection. Under live X-ray and while you are sedated, we inject just a few drops of numbing medication into your disk space. With a significant pain drop, the diagnosis is now proven.