Background: To accurately assess the effect of any therapy for treating discogenic low
back pain, the natural history of such pain should be known beforehand. However, until
now, no pathological characteristic could be used to predict the disease course of low
back pain.
Objective: To better instruct the clinical treatment of discogenic low back pain, a
prospective clinical study was performed to observe the natural history of the disease.
Study Design: A prospective clinical study during a 4-year follow-up period.
Setting: The study was performed at a spinal center in China.
Methods: A total of 279 patients with chronic low back pain were included from June
2006 through October 2007. Using discography, 156 patients (56%) were diagnosed to
have discogenic back pain. A 101-point numerical rating scale (NRS) was used to assess
the back pain symptoms and the Oswestry Disability Index (ODI) was used to assess lumbar
function.
Results: Of the 156 patients, 131 (84%) completed the study at 4-year follow-up. At the
end of follow-up, 17 patients (13.0%) had their low back pain symptoms alleviated and
lumbar function improved; 10 patients (7.6%) were slightly improved; 16 patients (12.2%)
had their symptoms aggravated; and 88 patients (67.2%) experienced the same pain and
disability as before. Although the average NRS and ODI scores obtained during the 4-year
follow-up study gradually decreased, statistical significances were found in such changes
(P < 0.05,and P < 0.05, respectively); however, the improvement rates of both pain (7.6%)
and disability (5.2%) were very low.
Limitations: The shortcoming of this study is its relatively small sample size.
Conclusion: The present study indicated that the natural history of discogenic low back
pain was chronic but persistent, and that the pain and disability in most patients did not
improve over time.
Key words: Discogenic low back pain, chronic low back pain, lumbar discography, painful
disc, black disc, disc degeneration, internal disc disruption, natural history, prognosis.
Therapeutic guidelines in chronic low back pain