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As we age, our bodies undergo many changes. Similar gradual changes affect the spine’s structures, notably the intervertebral discs. Discogenic back pain is the pain originating from a damaged dehydrated and deteriorated vertebral disc particularly due to degenerative disc disease (DDD). Early disc degeneration may not cause severe pain or other symptoms, but when the degeneration becomes advanced low back pain may occur. Typically, discogenic pain is associated with activities that increase the pressure within the intervertebral disc (called intradiscal pressure). Sitting, bending forward, coughing and sneezing can increase low back discogenic pain. Leg pain caused by pinching of the nerves in the low back (called radiculopathy) may also accompany low back discogenic pain, especially while sitting, standing or walking. Discogenic low back pain is usually a chronic disorder.
ConditionCausesSymptomsDiagnosis, Treatment & Recovery
Just like other parts of the body, each intervertebral disc has a nerve supply. Discs are comprised of two parts: the annulus fibrosus (outer ring-like structure) and nucleus pulposus (gel-like interior). The nucleus pulposus is void of nerves. However, the outer third of the annulus fibrosus contains nerve fibers. With trauma or normal degeneration of the spine, the disc can develop micro tears in the outer layers of the annulus fibrosus. These tears can expose the nerve fibers in the annulus and the spinal nerve to the inner nucleus pulposus. The nerve fibers and spinal nerves can become irritated by the acidity of the inner degenerative nucleus leaking out through a annular tear thus produce a great deal of pain.
When DDD and annular tears become prevalent the following symptoms are associated with this condition:
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 always recommended that patient be prescribed non-surgical conservative treatment initially to help relieve symptoms.
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 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.
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 procedure has shown great results in minimizing in most cases and alleviating pain altogether in some cases:
Our Least Invasive Procedure patients’ can begin getting out of bed one hour after surgery and go home shortly afterwards. There will probably be some pain after the procedure and is usually localized to the incision site. Activity is gradually increased and patients can return to non-physical work as early as two weeks. Keep in mind just because there is less or no pain, always consult your physician before beginning any physical work.
Our Minimally Invasive Spine Surgery patients’ post-operative recovery is much longer and may involve overnight stay in the hospital. Once your pain in under control you can go home. Dr. Rodriguez will give you medication to control your pain while you recover at home.
At home, you will need to continue to rest. You will be instructed on how to gradually increase your activity. You may still need to take the pain medications for a while. However, pain and discomfort should begin to reduce within a couple of weeks after surgery. The doctor will discuss with you other techniques for reducing pain and increasing flexibility before you leave for home. MIS patients can return to non-physical work as early as four to six weeks. Spine fusion patients can return to non-physical work as early as two to three months.
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Dr. Marco Rodriguez is a board-certified and fellowship trained orthopedic spine surgeon who specializes in compassionate care for spine patients utilizing least invasive and minimally invasive spine surgery techniques.
Kenner LA Office 3705 Florida Ave.Kenner, LA 70065
Baton Rouge Office 606 Colonial Dr Ste A Baton Rouge, LA, 70806
Spinal Injections
Endoscopic Rhizotomy
Artificial Disc Replacement
(504) 620-5520