Discogenic Back PainNon-surgical management

Dr Ashok Jadon,MD,DNB,MNAMS, FIPM (Ind), FIPP (USA)Chief Consultant & HOD Anaesthesia

In-charge Pain Relief ServiceTata Motors Hospital

Jamshedpur

Back Pain; profile• Low back pain is the 5th most common reason

for all physician visits.• Low back pain is responsible for more than

$20 billion annually in direct health care costs(USA).

• Approximately 90% of adults experience back pain at some time in life.

• 90% do not require intervention

Causes of Back Pain

25-40% Back Pain(Discogenic Back Pain)

Muscles,Tendons,Ligamaents

Discogenic Back Pain; Intervertebral Disc

Discogenic back pain

Stages of Disc Degeneration

A may last forever or, E may be First to occur

Degenerated Disc

Annuloplasty Disc Decompression

Chemonucleolysis

Annular Tear; High intensity zone

HIZ

I-DETIntradiscal Electrothermal Therapy

Biaculoplasty (Cooled RF)

Disc Herniation; Discectomy

Hydrodiscectomy (Spine jet®)

Laser and RF Plasma

Percutaneous Nucleotomy

Dekompressor

Ozone Neucleolysis

Future of Non surgical Treatment

Debate is on…….

Non-surgical Vs. Surgical ApproachRole of Surgery ?

Indication of Surgery

RED FLAGS

Contained Non-Contained

Back Pain; MRI & Disc Prolapse• MRI abnormalities need not have a clinical

significance. • 30% disc prolapse a-symptomatic*• MRI is72% sensitive, 68% specific, and 70%

accurate in detecting containment status of lumbar herniated discs.

http://thepainsource.com/abnormal-lumbar-disc-pathology-in-asymptomatic-individuals/

MRI; Back Pain

Provocative discography

Surgery for back pain;MRI…

• Clinical correlation is must• Discography is very helpful

Remember:FBSS 30%

Re-surgery; failure & risk

Summary

• Disc contributes 25-40% back pain • Only 10% patients require Intervention• MRI alone does not guarantee the diagnosis of

discogenic pain• Until supported by clinical judgment and

discography• Surgery is indicated in selected cases specially

sequestrated disc and emergent situation

Take home message……

• Non-surgical management is very safe & successful in

most of the patients.

Questions Please?

Thank you