Clinical diagnosis for discogenic low back pain

Yin-gang Zhang, Tuan-mao Guo, Xiong Guo, Shi-xun Wu, Yin-gang Zhang, Tuan-mao Guo, Xiong Guo, Shi-xun Wu

Abstract

Discogenic lower back pain (DLBP) is the most common type of chronic lower back pain (LBP), accounting for 39% of cases, compared to 30% of cases due to disc herniation, and even lower prevalence rates for other causes, such as zygapophysial joint pain. Only a small proportion (approximately 20%) of LBP cases can be attributed with reasonable certainty to a pathologic or anatomical entity. Thus, diagnosing the cause of LBP represents the biggest challenge for doctors in this field. In this review, we summarize the process of obtaining a clinical diagnosis of DLBP and discuss the potential for serum-based diagnosis in the near future. The use of serum biomarkers to diagnose DLBP is likely to increase the ease of diagnosis as well as produce more accurate and reproducible results.

Keywords: clinical diagnosis; discogenic lower back pain; serum proteomics.

Conflict of interest statement

Conflict of Interest: The authors have declared that no conflict of interest exists.

Figures

Figure 1
Figure 1
The pathogenesis of discogenic lower back pain
Figure 2
Figure 2
T1 (A)- and T2 (B)-weighted MRI images of the spine show intervertebral disc signal intensity variations. Arrows point to pathological features (Adopted from Majumdar 18).
Figure 3
Figure 3
Sagittal T2-weighted magnetic resonance image (MRI) shows a high-intensity zone (arrow) within the posterior annulus at L4-L5 (a). Axial T2-weighted MRI shows a high-intensity zone (arrow) within the posterior annulus at L4-L5 (b). The rectangle indicates the range of disc excision (PLIF procedure) that is used for histological examination (Adopted from Baogan Peng et al. 26).
Figure 4
Figure 4
MC classification (Adopted from Yue-Hui Zhang et al. 33)
Figure 5
Figure 5
Lateral discograms show a type 2 lobular pattern at L2-L3 (arrowhead), a type 5 ruptured pattern at L3-L4 (white arrow), and a type 4 fissured pattern at L4-L5 (black arrow). The patient was painless at L2-L3 and had concordant pain at L3-L4 and L4-L5 during discography. (Adopted from Chae-Hun Lim, et al. 47).
Figure 6
Figure 6
CLINPROT: biomarker profiling

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