![]() Treatment options in the past have centered primarily around pharmacological and/or surgical interventions. Discogenic pain is typically confirmed when symptoms are reproduced/‘provoked’ in provocation discography. Pain as a result of disc degeneration/pathology commonly presents as central low back pain though may be associated with referral to surrounding tissues or even the lower limb with this pain reportedly resulting from aberrant healing responses within the structure of the disc and the disc becoming densely innervated. Still, it has been shown that it occurs more frequently in the lumbar spine, is more common in women than in men, and degeneration can increase depending on disc position with degeneration increasing as one progresses caudally down the spinal column and disc height reduction being reported at levels of 3–15%/year. The prevalence and progression of disc height reduction over 12 months has been reported in a number of papers with varying populations. The hallmarks of DDD are reduced disc height and disc desiccation. The pathology is also characterized by secondary marginal vertebral body osteophyte formation, possible shrinkage of the nucleus pulposus and prolapse or folding of the annulus. The vertebral endplate is subject to fatigue failure causing de-aggregation of proteoglycans in the nucleus, a reduction in water content and non-collagenous proteins, consequent depressurization of the nucleus pulposus and delamination of the annulus fibrosus. The etiology of degenerative disc disease (DDD) is well established. The intervertebral disc (IVD) is a common source of LBP, being the prime source in about 40% of complex chronic LBP presentations and discogenic LBP often has a poor prognosis. In Australia, the most frequently seen musculoskeletal conditions in general practice are associated with back problems, with approximately 11% of the population experiencing high-disability LBP. ![]() LBP is the second most common reason for physician visits and work disability and is associated with substantial healthcare costs and work absenteeism. Low back pain (LBP) is a major health problem, affecting approximately 60–80% of the adult population at some stage in their life.
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