Intervertebral disc a source of pain? Low back pain: problems and future directions--case reports.

OBJECTIVE: The objective of this article is to provide evidence supporting the idea that intervertebral disc is a source of low back pain. SUMMARY OF BACKGROUND DATA: Diagnostic tests currently available for diagnosis of a painful disc are inadequate. Treatment protocols for low back pain generally ignore the presence of a painful disc. Pathological processes that may be responsible for discogenic pain are incompletely understood. Without diagnosis and treatment, disc disruption evolves to advanced stages of spinal dysfunction. New treatment modalities are becoming available which if applied early may stop disc disruption. CASE REPORTS: We describe here two case reports where discogenic nature of patients' symptoms was suspected based on patients' history, MRI findings and discography. We highlight the inadequacies of spinal imaging and discography in detecting at painful disc. A treatment (Intradiscal electrothermal therapy) was then directed exclusively to the intervertebral discs. We provide arguments that link discal therapy to resolution of patients' symptoms. Resolution of patients' symptoms after the discal treatment raised our suspicion that pain emanated from the intervertebral discs. CONCLUSIONS: Intervertebral disc is a source of low back pain that is often ignored. No diagnostic test currently exists that can reliably confirm presence of a painful disc. Early diagnosis and treatment of a painful disc may reduce enormous pain and suffering from low back pain.