The different interventional modalities for treatment of discogenic pain

The intervertebral discs lie between the vertebral bodies, linking them together. The components of the disc are nucleus pulposus, annulus fibrosus and cartilagenous endplates. The blood supply to the disc is only to the cartilaginous end-plates. The nerve supply is basically through the sinovertebral nerve. Biochemically, the important constituents of the disc are collagen fibers, elastin fibers and aggrecan. As the disc ages, degeneration occurs, osmotic pressure is lost in the nucleus, dehydration occurs, and the disc loses its height. During these changes, nociceptive nuclear material tracks and leaks through the outer rim of the annulus. This is the main source of discogenic pain.Lumbar discography, provocative discography, and disc manometry are all examinations whose goal is to determine whether a intervertebral disc is the cause of patients’ pain symptoms. In spite of the unceasing stream of contradictory literature, provocative discography remains the gold standard for the determination of the diagnosis of discogenic pain.Various interventional treatment strategies for chronic discogenic low back pain unresponsive to conservative care include reduction of inflammation, ablation of intradiscal nociceptors, lowering intranuclear pressure, removal of herniated nucleus, and radiofrequency ablation of the nociceptors.