Discogenic low back pain

Discogenic low back pain

Discogenic low back pain has been defined as a continuum of diagnostic categories (internal disc disruption, degenerative disc disease, segmental instability) reflecting various stages of degenerative pathology a ff ecting the intervertebral disc. Not all degenerate discs are painful. Patients typically present with chronic relapsing episodes of low back pain between the ages of 40 and 60 years. A recent study has compared rehabilitation with spinal fusion for discogenic pain. Both groups reported reductions in disability , with the authors strongly recommending a course of rehabilitation before surgical intervention. For those who fail to improve with conservative measures, provocative lum - bar discography ( Figure 37.1 ) may help to identify the source of pain, and surgery in the form of a lumbar spinal fusion - ( Figure 37.3 ) or lumbar disc replacement ( Figure 37.4 ) may be considered. J E Buck , surgeon, Brook General Hospital, London, UK, described the direct repair of the defect in spondylolisthesis in 1970.

(b) (c) Figure 37.3 Anterior lumbar interbody fusion. (a) The PEEK (poly-ethyl-ethyl-ketone) cage has been packed with bone graft prior to insertion; (b, c) show the anteroposterior and lateral postoperative radiographs, respectively. (b) Figure 37.4 Lumbar total disc replacement. (a) Anteroposterior radio

graph with 30° of cranial inclination. (b) Lateral radiograph with the implant appropriately positioned.

Discogenic low back pain

Discogenic low back pain has been defined as a continuum of diagnostic categories (internal disc disruption, degenerative disc disease, segmental instability) reflecting various stages of degenerative pathology a ff ecting the intervertebral disc. Not all degenerate discs are painful. Patients typically present with chronic relapsing episodes of low back pain between the ages of 40 and 60 years. A recent study has compared rehabilitation with spinal fusion for discogenic pain. Both groups reported reductions in disability , with the authors strongly recommending a course of rehabilitation before surgical intervention. For those who fail to improve with conservative measures, provocative lum - bar discography ( Figure 37.1 ) may help to identify the source of pain, and surgery in the form of a lumbar spinal fusion - ( Figure 37.3 ) or lumbar disc replacement ( Figure 37.4 ) may be considered. J E Buck , surgeon, Brook General Hospital, London, UK, described the direct repair of the defect in spondylolisthesis in 1970.

(b) (c) Figure 37.3 Anterior lumbar interbody fusion. (a) The PEEK (poly-ethyl-ethyl-ketone) cage has been packed with bone graft prior to insertion; (b, c) show the anteroposterior and lateral postoperative radiographs, respectively. (b) Figure 37.4 Lumbar total disc replacement. (a) Anteroposterior radio

graph with 30° of cranial inclination. (b) Lateral radiograph with the implant appropriately positioned.

Discogenic low back pain

Discogenic low back pain has been defined as a continuum of diagnostic categories (internal disc disruption, degenerative disc disease, segmental instability) reflecting various stages of degenerative pathology a ff ecting the intervertebral disc. Not all degenerate discs are painful. Patients typically present with chronic relapsing episodes of low back pain between the ages of 40 and 60 years. A recent study has compared rehabilitation with spinal fusion for discogenic pain. Both groups reported reductions in disability , with the authors strongly recommending a course of rehabilitation before surgical intervention. For those who fail to improve with conservative measures, provocative lum - bar discography ( Figure 37.1 ) may help to identify the source of pain, and surgery in the form of a lumbar spinal fusion - ( Figure 37.3 ) or lumbar disc replacement ( Figure 37.4 ) may be considered. J E Buck , surgeon, Brook General Hospital, London, UK, described the direct repair of the defect in spondylolisthesis in 1970.

(b) (c) Figure 37.3 Anterior lumbar interbody fusion. (a) The PEEK (poly-ethyl-ethyl-ketone) cage has been packed with bone graft prior to insertion; (b, c) show the anteroposterior and lateral postoperative radiographs, respectively. (b) Figure 37.4 Lumbar total disc replacement. (a) Anteroposterior radio

graph with 30° of cranial inclination. (b) Lateral radiograph with the implant appropriately positioned.