Back Pain

Discogenic Back Pain

There are many people who suffer from low back pain and sciatica who have been labeled and written off as “chronic low back pain”.  The source of their pain is not adequately diagnosed and therefore they have not been offered any kind of effective treatment.  They become disabled, they can’t work, they are drug dependent and depressed.

The problem I am referring to is degenerative disc disease.  A process whereby the disc collapses degenerates and becomes unstable.  The disc capsule and joints can, when standing, even push on the nerve and cause sciatica even though the MRI may not show a herniated disc.  Discogenic disease can be caused from a combination of factors, including, genetics, injury, overuse, previous surgery and smoking.

If you have low back pain that has not responded to conservative management such as therapy, chiropractic and medication then it is time to expand the testing.  An MRI already has been done by now.  If you have a herniated disc that has not responded in the past 3 – 6 months then you would be a candidate for a microdiscectomy. A common operation that has a high success rate.  More commonly, however, the MRI will show only some degree of disc degeneration or a disc bulge, and you may be advised to live with the pain and continue conservative treatment.  Some people continue like this for years, and suffer for years.

At this point a patient should undergo a workup at our spine care center.  Here, a variety of diagnostics will be performed.  The most important is the discogram.  A test where the disc is injected and provoked.  We, and the patient, can see first hand if the disc or discs are causing the low back pain.  We can inject the disc with dye and take x-rays.  The damaged internal structure can be clearly evaluated.  Disc bulging and nerve compression can be seen as well, even when it is not seen on the MRI.

Once the exact source of pain is identified, a treatment plan can be formulated.  Some people may be candidates for non-operative treatment such as chemical or radiofrequency ablation.  Others may require operative treatment.

Today, a disc can be removed and fused using Endoscopic and Laparoscopic surgical techniques. Using 3 or 4 small incisions in the abdomen we can, with the aid of a TV camera, perform a disc excision and fusion with a titanium fusion cage.  This obviates the need for painful dissection around the spinal cord and back muscles.  Postoperative pain is less; recovery is quicker, and most importantly, there is no chance of problems from scarring around the nerves and spinal cord.  This scarring is a frequent cause of failure following spine surgery.  In fact, people who have scarring from previous surgery may be helped significantly from this type of fusion.  The anterior procedure is ideal.  Fusions can be obtained without invading the spinal canal and worsening an already painful problem.

Not all patients are candidates for anterior fusion.  Posterior procedures work very well and should be used when decompressions are necessary, or when instability exists.  More recently, total disk replacements have become available.  it is my opinion that these procedures should be avoided by most as the exact complication rate and long term results are not precisely known yet.