Topical review Discogenic pain

Lumbar disc disease characterized by symptomatic disc herniation or typical sciatica is a major challenge for health care. Its prevalence was studied as part of the Mini-Finland Health Survey in a sample of over 7000 Finnish adults. A diagnosis of lumbar disc syndrome based on medical history, symptoms, and standardized physical examination was made for 5.1% of the men and for 3.7% of the women. One third of all patients with lumbar disc syndrome had been previously hospitalized with it, and one fifth of the patients had undergone lumbar surgery. About 6% of the population’s work disability was estimated to be attributable to lumbar disc syndrome (Heliövaara et al., 1987). Beyond the more specific herniation problem, discogenic origin has been assumed to be a major cause of non-specific low back pain (LBP). In a population of chronic LBP patients 39% had an internal disc disruption, with concordant pain provocation in discography indicating the discogenic origin of their pain (Schwarzer et al., 1995). Furthermore, disc degeneration is considered to be the initiating event that leads to secondary deterioration of the facets, ligaments, and muscles. The spine and discs in particular are very specific both anatomically and functionally compared with the peripheral joints. While degenerative knee changes are relatively rare in elderly people, nearly all exhibit disc and spinal degeneration. Additionally, while few subjects with severe gonarthoris are asymptomatic, the reverse holds true for many people with severe degenerative spinal changes. Furthermore, the findings of degenerative images on MRI of