Provocative discography and minimally invasive procedures for the treatment of discogenic pain

摘要

Diagnosis and treatment of lumbar discogenic pain remains a challenge.It may account for 1/3 of patients with lower back pain. The mechanism ofdiscogenic pain remains unclear, clinical presentation can vary and theMRI may only suggest the presence of internal disc disruption. Provocativediscography can provide unique information about the morphology of thedisc and remains the only diagnostic test that can relate the changes observedon imaging tests and the patient's pain. Minimally invasive treatments likeintradiscal biacuplasty or intradiscal electrothermal therapy are likely betteralternatives to the currently available surgical options. They are cost effec-tive and may cause fewer side effects. However; the value of most of thesetherapies has yet to be established. More basic science and clinical studies areneeded to prove the clinical efficacy of such minimal invasive treatments.One thing that is clear, however, is that the careful patient selection, basedon the present data, significantly improves successes of these procedures.