The concept of discogenic cervical and low back pain In recent years, many scholars have conducted in-depth studies on the neuroanatomical biochemistry and biomechanics of the intervertebral disc before and after degeneration or injury, and it has been gradually recognized that in the absence of disc herniation, lesions occurring within the intervertebral disc can also cause cervical and low back pain – called discogenic cervical and low back pain. These pathologic changes are called intradiscal disorders (IDD). The pathogenesis of discogenic cervical and lumbar pain is stimulated by intradiscal chemicals: many studies in recent years have shown that the process of disc degeneration or injury can produce a large number of inflammatory mediators or degeneration products, and the stimulation of peripheral nerve fibers by these chemicals can put the nerve tissue in a hyperactive state.
The stimulation of these chemicals on the peripheral nerve fibers can put the nerve tissue in a hypersensitive state and cause pain with minor external stimulation. The appearance of fissures in the annulus fibrosus at the posterior edge of the disc: the appearance of fissures from the nucleus pulposus to the outer layer of the annulus fibrosus; the invasion of granulation tissue and the exudation of inflammatory cells; the formation of inflammatory granulation tissue bands in the posterior aspect of the disc; the production of growth factors associated with healing and growth; and the degeneration and inflammation of the disc under the action of these factors, resulting in discogenic pain. Changes in mechanical pressure within the intervertebral disc: It is currently believed that due to the very high content of inflammatory mediators within the degenerated disc, the injury receptors at the sinus nerve terminals are in a hypersensitive state under the action of inflammatory mediators, resulting in a decrease in the pain threshold to mechanical pressure, and nerve impulses can be generated under mild mechanical pressure stimulation. Discogenic lower back pain Extremely common and clinically prevalent, it is a loss-of-function lower back pain caused by stimulation of pain receptors within the intervertebral disc by various intravertebral diseases (e.g., degeneration, endplate injury, etc.), not associated with radiculopathy, without radiographic evidence of nerve root compression, and can be described as chemically mediated discogenic pain. Diagnostic criteria There is no gold standard for diagnosis, and it is generally believed that the following conditions must be met: 1. Recurrent episodes of lower back pain symptoms lasting >6 months. 2, persistent lower back pain aggravated in sitting position without radicular symptoms. 3, Positive discography or MR performance typical of lesions with low signal in the disc and high signal areas in the posterior part of the fibrous ring.