Discogenic low back pain has been referred to as a lumbar disc disorder, which is similar to the concept of a knee disorder, i.e., a broad term given to “disorder” when the etiology is uncertain and symptoms occur. In recent years, the etiology of discogenic low back pain has been clarified by basic research and objective imaging findings. Discogenic low back pain is caused by the rupture of the inner fibrous annulus of the lumbar intervertebral disc due to degeneration and the entry of nucleus pulposus tissue into the spinal canal through the ruptured posterior fibrous annulus, resulting in a local autoimmune inflammatory response that causes pain. As determined by biochemical and immunohistochemical methods, inflammatory mediators such as phosphodiesterase A2, IL-I, IL-IV, and PGE2 can be detected at the posterior aspect of the annulus fibrosus or at the dorsal root ganglion, and these inflammatory mediators stimulate the injury receptors within the outer annulus fibrosus to produce pain. This type of disc with early and mild degeneration has a ruptured fibrous annulus in the posterior central part and therefore presents as low back pain. This type of low back pain is different from mechanical back pain (mechnanicallow back pain), which has a different pain pathology due to lumbar disc degeneration or other causes of lumbar spine instability. Clinically, they are different. Lumbar discogenic pain is persistent low back pain and static pain. Mechanical lumbar pain is intermittent and dynamic with lumbar motion. In discogenic low back pain, as degeneration progresses, rupture of the annulus fibrosus often affects the posterior lateral aspect of the annulus fibrosus, causing the common posterior lateral disc herniation, which produces lumbosacral radicular pain. Because the nature, extent, and duration of discogenic low back pain are not specific, the inflammatory mediators identified in experimental studies are virtually undetectable in the clinical setting. Imaging plays an important role in the diagnosis of discogenic low back pain. No significant narrowing of the lumbar intervertebral space was demonstrated on radiographs, and no lumbar instability was observed on dynamic lumbar spine radiographs, i.e., no displacement >3 mm and angular position difference >11º between adjacent vertebrae in lumbar hyperextension and hyperflexion. MRIT2-weighted lesions had reduced disc signal. The important sign is a small garden or oval-shaped high signal area in the mid-sagittal position in the posterior median of the disc adjacent to the upper endplate of the next vertebral body. This is an important MRI sign to confirm discogenic pain. The discography pain provocation test is an important invasive test. It is mainly used to determine the responsible disc when lumbosacral nerve root pain is caused by multi-segmental degeneration of the lumbar disc. In the diagnosis of discogenic low back pain, a positive discography pain provocation test should be accompanied by the following three criteria: ① absence of pain in the adjacent control disc; ② spillage of contrast from the outer fibrous annulus of the diseased intervertebral space. (iii) Pain consistent with the diseased intervertebral space. This discography pain provocation test is not only used as the gold standard for the diagnosis of lumbar discogenic low back pain, but also as a target for surgical treatment when non-surgical treatment is ineffective for more than six months when the symptoms are severe.