Discogenic Back Pain: The Case for Surgery

摘要

One of the more controversial topics in the treatment of spinal disorders is the management of patients with low back pain and radiographic evidence of degenerative disc changes. The clinical condition of low back pain without radicular pain and without neurogenic claudication has been referred to as "discogenic back pain." It is generally agreed that pharmaceutical management and physical therapy play a primary and important role in the management of all patients with discogenic back pain. A variety of invasive, nonsurgical treatments have been found to be helpful in the management of these patients. It is generally agreed that all patients with discogenic back pain should undergo nonsurgical treatment. As this diagnosis excludes patients with any neurological deficit or even significant radicular pain, there is no role for urgent surgical intervention. Van Tulder et al. and Mannion et al. (and others) point out that, despite a lack of consensus, various physical therapy regimens have benefit.More aggressive interventions such as epidural steroid injections, facet joint injections, facet joint radiofrequency rhizotomy, intradiscal electrothermoplasty, acupuncture, and chiropractic manipulation are gaining in popularity. The more difficult and controversial decision is the selection of patients for surgical intervention when such appropriate physical therapy and invasive intervention fails to help a patient with discogenic back pain.