The Treatment of Discogenic Low Back Pain: An Integrated Approach

The literature recognizes the disc as the probable pain generator in the majority of patients with low back pain. Kuslich S, et al. performed progressive local anesthesia on patients with low back pain and noted their response to tissue stimulation during operations on the lumbar spine 9. He found the annulus and nerve root to be the pain generator in the majority of cases. The facet joint capsule was an infrequent pain generator. Smyth and Wright placed nylon threads into various lumbar tissues while performing certain lumbar spinal operations and exerted tension on the threads18. This study indicated that the annulus was the most common site of low back pain and the compressed nerve root was responsible for sciatica. Hirsch C. carefully placed needles into the lumbar spine of awake patients and stimulation of the posterior portion of the annulus resulted in pain in the majority 6. Mooney V. concludes that the source of chronic low back pain in the majority of cases is the disc 12. Nachemson A. implicates the disc as the most likely cause of pain and provides indirect proof13. We accept the fact the disc acts hydrostatically or not 11. Donelson, Aprill, Metcalf, and Grant utilized CT discography after McKenzie assessment in an attempt to correlate symptomatic discs with anular competence 3. Seventy-four percent of the centralizers ha