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Low back pain from degenerative disc disease can be severe and cause depression, lost time from work, and hinder recreational activities. How does a doctor diagnose the problem? And then how does a doctor guarantee that the problem intervertebral disk is the cause of one’s back pain?
The intervertebral lumbar disk is made of two parts analagous to a jelly donut. The inside part, the jelly, is known as the nucleus pulposus and does not cause any pain. The outer part, the anulus fibrosus, does have nerve endings and if they are injured the individual can have acute and potentially chronic back pain as a result.
When a patient has back pain, the work up includes the following.
History and Physical – Typically the patient has pain located in the low back, and often aggravated while sitting and in flexion posture. Studies have shown flexion positions actually increase pressure on the lumbar disc.
X-rays – Plain films are a standard initial imaging workup. Plain films can show degenerative disc disease as a decreased space between the vertebrae so there is less space between the bones. Hence, this is an indirect diagnosis. Be aware that x-rays may show a decrease in disk height that reflects degenerative disk disease but may not in fact be the source of one’s pain.
MRI – A Magnetic Resonance Image is very good at noticing differences in the soft tissues of the musculoskeletal system. If a lumbar disk is degenerated, the MRI will detect the loss of water and the disc will show up dark on the scan. Also an MRI can sometimes show a tear in the outer part of the lumbar disk, the anulus. As with x-rays, an MRI can suggest that a lumbar disc that is degenerative may be producing back pain, but may just be an incidental finding.
Lumbar Discogram – A discogram is a study meant to delineate if the lumbar disk is the source of low back pain. Discograms are done with sedation, however, the patient is not out completely since the pain doctor needs input during the study from the patient. Usually a control level is included at a disc level thought to be normal. The pain doctor places the needle into the disk space and injects dye along with the fluid. This fluid is designed to raise intradiscal pressure and produce pain from the degenerated disk. There are three potential answers. One is the person has no pain. Two is the patient has pain from the fluid that is unlike what he experiences on a daily basis. That constitutes a negative study at that particular level. Three is the individual has the exact same pain he or she has on a daily basis. That is therefore a positive study. A diskogram therefore has no true therapeutic benefit and does not relieve pain, it actually creates it! The study serves a diagnostic benefit for pre-operative planning.
Currently the studies used to diagnose degenerative disk disease, known as DDD, are the best modern medicine has to offer. There is not one study that is definitive.