Revised: March 19, 2013
Accepted: April 10, 2013
Published online: April 18, 2013
Discogenic low back pain is a serious medical and social problem, and accounts for 26%-42% of the patients with chronic low back pain. Recent studies found that the pathologic features of discs obtained from the patients with discogenic low back pain were the formation of the zones of vascularized granulation tissue, with extensive innervation in fissures extending from the outer part of the annulus into the nucleus pulposus. Studies suggested that the degeneration of the painful disc might originate from the injury and subsequent repair of annulus fibrosus. Growth factors such as basic fibroblast growth factor, transforming growth factor β1, and connective tissue growth factor, macrophages and mast cells might play a key role in the repair of the injured annulus fibrosus and subsequent disc degeneration. Although there exist controversies about the role of discography as a diagnostic test, provocation discography still is the only available means by which to identify a painful disc. A recent study has classified discogenic low back pain into two types that were annular disruption-induced low back pain and internal endplate disruption-induced low back pain, which have been fully supported by clinical and theoretical bases. Current treatment options for discogenic back pain range from medicinal anti-inflammation strategy to invasive procedures including spine fusion and recently spinal arthroplasty. However, these treatments are limited to relieving symptoms, with no attempt to restore the disc’s structure. Recently, there has been a growing interest in developing strategies that aim to repair or regenerate the degenerated disc biologically.
Core tip: Discogenic low back pain is the most common type of chronic low back pain. Why lumbar disc degeneration leads to pain is one of the most important topics in medical field. Studies have revealed that pathologic features of painful discs were the formation of the zones of vascularized granulation tissue, with extensive innervation in annular fissures. Provocation discography now still is the only available means by which to identify a painful disc. There are a multitude of treatments used in clinical practice to treat chronic low back pain, with little consensus amongst clinicians as to which is the best approach.