Discogenic Back Pain

by Dr. David Kramer

Do you have lower back pain?

It is this disconnect between the appearance of a degenerated disc on MRI or x-ray, and the existence of lower back pain, that makes obtaining a second opinion regarding diagnosis of your back/neck pain critical.

 

Lumbar disc degeneration is the result of deterioration of the mechanical and chemical properties of the disc. The cause typically is the combination of the aging process aggravated by environmental factor such as trauma, high-impact activity, type of work, and smoking. Genetics cdiscogenic back pain, lower back painan also lead to a predisposition toward accelerated degeneration of the disc. The actual physical and chemical changes that occur with aging include loss of water in the soft central portion of the disc (called the nucleus), as well as within the outer fibrous layers of the disc (referred to as the annulus).  The end stage of this loss of water content within the disc is intradiscal fibrosis, resulting in loss of disc height on x-ray, and darkening of the disc on MRI Ultimately, the adjacent vertebrae may trend toward autofusion with fibrous tissue replacing the gelatinous central nucleus, thereby reducing movement between the adjacent vertebrae. This may, to some degree, explain why we get stiffer as we get older and why the vast majority of individuals grow older without back pain. It is, therefore, a fairly universal phenomenon that we all experience progressive disc degeneration beyond the age of 30.

While it may be tempting to look at x-rays or MRI scans and single out those discs that appear most degenerated as the likely source of individuals’ pain, this is not always the case. For instance, when one looks at the population of 80-year-old individuals, not surprisingly, they all have quite advanced degenerative changes in their discs and advanced arthritic changes in their vertebrae on x-ray and MRI, and yet, as a group, they tend to have the lowest incidence of low back pain.

It is this disconnect between the appearance of a degenerated disc on MRI or x-ray, and the existence of lower back pain, that makes obtaining a second opinion regarding diagnosis of your back/neck pain critical.

Dr. David Kramer

About Dr. David Kramer

Director of the Western Connecticut Health Network Spine Center since 2005, and with over 16 years in practice as a specialist in complex spinal surgery, Dr. Kramer conducts his spine practice at Connecticut Neck and Back Specialists in Danbury, Connecticut. He has been certified by the American Board of Orthopedic Surgeons since 1998. After earning his bachelors... Read More »