Discogenic Back Pain Diagnosis & Treatments
How to Diagnose Disc Tear/Discogenic Back Pain?
Accurate and thorough diagnosis is key to selecting the best treatment options. An MRI is a significant diagnostic tool that allows the physician to observe any abnormalities or changes in the spine and the disc. On an MRI, disc tears can show up as a white high intensity zone on the posterior disc. In addition to the MRI, if one or more spinal discs are suspected as the pain source, the doctor may order a provocative discogram or discography. During this sterile procedure, the suspect discs are injected with a contrast dye to make each disc visible under fluoroscopy. Provocative discography helps the doctor to see the shape and size of the intervertebral disc. The injection of the contrast dye alters the pressure within the disc and may ‘provoke’ or reproduce the patient’s pain pattern thereby helping to isolate a particular disc as a pain generator.
What are the Treatment Options for Discogenic Back Pain?
Treatment for discogenic back pain ranges from conservative therapies to surgical intervention. The goals of treatment are to relieve pain, prevent or reduce stress on the discs or spinal nerves, and maintain normal function. It is almost always recommended that patients be prescribed nonsurgical, conservative treatment initially to help relieve symptoms.
- Medications: anti-inflammatories, muscle relaxers and, on rare occasions narcotic medications
- Heat/cold therapy
- Physical therapy exercises: including stretching, massage, and strengthening
- Epidural steroid injections are used two-fold; first to relieve inflammation of the affected spinal nerve, and secondly diagnostically to confirm the correct affected level from which the pain originates.
Least Invasive Procedures
Once conservative measures have been exhausted, and the patient is still in considerable pain after 6 months, then a minimally invasive procedure may be recommended. The following procedures has shown good results in minimizing in most cases and alleviating pain altogether in some cases:
- Endoscopic Discectomy: A ¼ inch incision is made and a 7mm operating tube is placed in the disc at the site of the annular tear. An endoscope with an HD camera is inserted into the operating tube to visualize the annulus and spinal nerves. Then the tear is debrided to make sure no nucleus pulposus is stuck within the annulus and thermally heated with bipolar instrument to reduce and close the tear.
Minimally Invasive Spine Surgery
- MIS Microdiscectomy – Usually an open procedure or using tubular retractor with an incision of 1 inch. The surgeon usually observes through a microscope or set of eyeglass loupes that help magnify the anatomy. Most of the pain post-operative is from the approach the surgeon made through muscle in your back. Anesthesia is necessary.
- MIS TLIF – The surgery involves removing the damaged intervertebral disc and replace it with a piece of bone or PEEK cage packed with bone to assist in union or fusion of the two vertebral bodies over time. Screws are used to hold the disc still until it fuses.