Skip to main content
SpringerLink
Log in

Discogenic Pain

  • Chapter
  • First Online:
A Case-Based Approach to Neck Pain

  • 338 Accesses

Abstract

This chapter examines neck pain that is due to pathology of the intervertebral disc. The biomechanical changes that result in discogenic pain are discussed in-depth in this chapter, including an explanation of the changes that occur on both the structural and chemical levels. Additionally, this chapter discusses the clinical presentation of discogenic cervical pain, common imaging findings that occur with disc pathology, and nonoperative and operative treatment strategies for discogenic neck pain.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 69.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 89.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Boos N, Weissbach S, Rohrbach H, Weiler C, Spratt KF, Nerlich AG. Classification of age-related changes in lumbar intervertebral discs. Spine (Phila Pa 1976). 2002; https://doi.org/10.1097/01.brs.0000035304.27153.5b.

  2. Ashton-Miller JA, Schmatz C, Schultz AB. Lumbar disc degeneration: correlation with age, sex, and spine level in 600 autopsy specimens. Spine (Phila Pa 1976). 1988; https://doi.org/10.1097/00007632-198802000-00008.

  3. Weiler C, Nerlich A, Zipperer J, Bachmeier B, Boos N. SSE award competition in basic science: expression of major matrix metalloproteinases is associated with intervertebral disc degradation and resorption. Eur Spine J. 2002;2002 https://doi.org/10.1007/s00586-002-0472-0.

  4. Coventry M. The intervertebral disc: its microscopic anatomy and pathology: part I. anatomy, development and pathology. J Bone Jt Surg. 1945;

    Google Scholar 

  5. Coventry MB, Ghormley RK, Kernohan JW. The intervertebral disc: its microscopic anatomy and pathology. J Bone Jt Surg. 1945;

    Google Scholar 

  6. Coventry M, Ghormley R, Kernohan J. The intervertebral disc: its microscopic anatomy and pathology: Part III. Pathological changes in the intervertebral disc. JBJS. 1945.

    Google Scholar 

  7. Siemionow K, An H, Masuda K, Andersson G, Cs-Szabo G. The effects of age, sex, ethnicity, and spinal level on the rate of intervertebral disc degeneration: a review of 1712 intervertebral discs. Spine (Phila Pa 1976). 2011; https://doi.org/10.1097/BRS.0b013e3181f2a177.

  8. Berg AJ, Ahmadje U, Jayanna HH, Trégouët P, Sanville P, Kapoor V. The prevalence of lumbar disc degeneration in symptomatic younger patients: a study of MRI scans. J Clin Orthop Trauma. 2020; https://doi.org/10.1016/j.jcot.2020.07.021.

  9. Theodore N. Degenerative cervical spondylosis. N Engl J Med. 2020; https://doi.org/10.1056/nejmra2003558.

  10. Feng H, Danfelter M, Strömqvist B, Heinegård D. Extracellular matrix in disc degeneration. J Bone Jt Surg Series A. 2006; https://doi.org/10.2106/JBJS.E.01341.

  11. Kirkaldy-Willis WH, Farfan HF. Instability of the lumbar spine. Clin Orthop Relat Res. 1982; https://doi.org/10.1097/00003086-198205000-00015.

  12. Lee MJ, Lindsey JD, Bransford RJ. Pedicle screw-based posterior dynamic stabilization in the lumbar spine. J Am Acad Orthop Surg. 2010; https://doi.org/10.5435/00124635-201010000-00001.

  13. Errico TJ, et al. “Biomechanics of the spine.” Spinal disorders and treatment the NYU-HJD comprehensive textbook, Jaypee, New Delhi U.a., 2015, pp. 11–17.

    Google Scholar 

  14. Sambrook PN, MacGregor AJ, Spector TD. Genetic influences on cervical and lumbar disc degeneration: a magnetic resonance imaging study in twins. Arthritis Rheum. 1999; https://doi.org/10.1002/1529-0131(199902)42:2<366::AID-ANR20>3.0.CO;2-6.

  15. De Schepper EIT, Damen J, Van Meurs JBJ, et al. The association between lumbar disc degeneration and low back pain: the influence of age, gender, and individual radiographic features. Spine (Phila Pa 1976). 2010; https://doi.org/10.1097/BRS.0b013e3181aa5b33.

  16. Iwahashi M, Matsuzaki H, Tokuhashi Y, Wakabayashi K, Uematsu Y. Mechanism of intervertebral disc degeneration caused by nicotine in rabbits to explicate intervertebral disc disorders caused by smoking. Spine (Phila Pa 1976). 2002; https://doi.org/10.1097/00007632-200207010-00005.

  17. Battié MC, Videman T, Gill K, Moneta GB. Smoking and lumbar intervertebral disc degeneration—an MRI study of identical twins. Spine (Phila Pa 1976). 1991;

    Google Scholar 

  18. Das UN. Is obesity an inflammatory condition? Nutrition. 2001; https://doi.org/10.1016/S0899-9007(01)00672-4.

  19. Samartzis D, Karppinen J, Mok F, Fong DYT, Luk KDK, Cheung KMC. A population-based study of juvenile disc degeneration and its association with overweight and obesity, low back pain, and diminished functional status. J Bone Jt Surg Ser A. 2011; https://doi.org/10.2106/JBJS.I.01568.

  20. Park CH, Min KB, Min JY, Kim DH, Seo KM, Kim DK. Strong association of type 2 diabetes with degenerative lumbar spine disorders. Sci Rep. 2021; https://doi.org/10.1038/s41598-021-95626-y.

  21. DePalma MJ, Ketchum JM, Saullo T. What is the source of chronic low back pain and does age play a role? Pain Med. 2011; https://doi.org/10.1111/j.1526-4637.2010.01045.x.

  22. Kos N, Gradisnik L, Velnar T. A brief review of the degenerative intervertebral disc disease. Med Arch (Sarajevo, Bosnia Herzegovina). 2019; https://doi.org/10.5455/medarh.2019.73.421-424.

  23. Kirnaz S, Capadona C, Lintz M, et al. Pathomechanism and biomechanics of degenerative disc disease: features of healthy and degenerated discs. Int J Spine Surg. 2021; https://doi.org/10.14444/8052.

  24. Solovieva S, Lohiniva J, Leino-Arjas P, et al. Intervertebral disc degeneration in relation to the COL9A3 and the IL-1β gene polymorphisms. Eur Spine J. 2006; https://doi.org/10.1007/s00586-005-0988-1.

  25. Noponen-Hietala N, Virtanen I, Karttunen R, et al. Genetic variations in IL6 associate with intervertebral disc disease characterized by sciatica. Pain. 2005; https://doi.org/10.1016/j.pain.2004.12.015.

  26. Noponen-Hietala N, Kyllönen E, Männikkö M, et al. Sequence variations in the collagen IX and XI genes are associated with degenerative lumbar spinal stenosis. Ann Rheum Dis. 2003; https://doi.org/10.1136/ard.2003.008334.

  27. Roughley P, Martens D, Rantakokko J, Alini M, Mwale F, Antoniou J. The involvement of aggrecan polymorphism in degeneration of human intervertebral disc and articular cartilage. Eur Cell Mater. 2006; https://doi.org/10.22203/eCM.v011a01.

  28. Kalb S, Martirosyan NL, Kalani MYS, Broc GG, Theodore N. Genetics of the degenerated intervertebral disc. World Neurosurg. 2012; https://doi.org/10.1016/j.wneu.2011.07.014.

  29. Kawaguchi Y, Osada R, Kanamori M, et al. Association between an aggrecan gene polymorphism and lumbar disc degeneration. Spine (Phila Pa 1976). 1999; https://doi.org/10.1097/00007632-199912010-00006.

  30. Videman T, Leppävuori J, Kaprio J, et al. Intragenic polymorphisms of the vitamin D receptor gene associated with intervertebral disc degeneration. Spine (Phila Pa 1976). 1998; https://doi.org/10.1097/00007632-199812010-00002.

  31. Videman T, Gibbons LE, Battié MC, et al. The relative roles of intragenic polymorphisms of the vitamin d receptor gene in lumbar spine degeneration and bone density. Spine (Phila Pa 1976). 2001; https://doi.org/10.1097/00007632-200102010-00003.

  32. Mayer JE, Iatridis JC, Chan D, Qureshi SA, Gottesman O, Hecht AC. Genetic polymorphisms associated with intervertebral disc degeneration. Spine J. 2013; https://doi.org/10.1016/j.spinee.2013.01.041.

  33. Kalichman L, Hunter DJ. The genetics of intervertebral disc degeneration. Associated genes. Jt Bone Spine. 2008; https://doi.org/10.1016/j.jbspin.2007.11.002.

  34. Podichetty VK. The aging spine: the role of inflammatory mediators in intervertebral disc degeneration. Cell Mol Biol. 2007; https://doi.org/10.1170/T814.

  35. Shamji MF, Setton LA, Jarvis W, et al. Proinflammatory cytokine expression profile in degenerated and herniated human intervertebral disc tissues. Arthritis Rheum. 2010; https://doi.org/10.1002/art.27444.

  36. Hunt WE, Miller CA. Management of cervical radiculopathy. Clin Neurosurg. 1986;

    Google Scholar 

  37. Errico TJ, et al. “Evaluation and examination of neck pain.” Spinal Disorders and Treatment the NYU-HJD Comprehensive Textbook, Jaypee, New Delhi U.a., 2015, pp. 36–42.

    Google Scholar 

  38. Mechanical disorders of the spine. In: Low Back and Neck Pain; 2004. https://doi.org/10.1016/b978-0-7216-9277-7.50018-0.

  39. Nordin M, Carragee EJ, Hogg-Johnson S, et al. Assessment of neck pain and its associated disorders. Results of the bone and joint decade 2000-2010 task force on neck pain and its associated disorders. J Manip Physiol Ther. 2009; https://doi.org/10.1016/j.jmpt.2008.11.016.

  40. Vernon H, Mior S. The neck disability index: a study of reliability and validity. J Manip Physiol Ther. 1991;

    Google Scholar 

  41. Matsumoto M, Fujimura Y, Suzuki N, et al. MRI of cervical intervertebral discs in asymptomatic subjects. J Bone Jt Surg Ser B. 1998; https://doi.org/10.1302/0301-620X.80B1.7929.

  42. Boden SD, McCowin PR, Davis DO, Dina TS, Mark AS, Wiesel S. Abnormal magnetic-resonance scans of the cervical spine in asymptomatic subjects. A prospective investigation. J Bone Jt Surg Ser A. 1990; https://doi.org/10.2106/00004623-199072080-00008.

  43. Douglas-Akinwande AC, Rydberg J, Shah MV, et al. Accuracy of contrast-enhanced MDCT and MRI for identifying the severity and cause of neural foraminal stenosis in cervical radiculopathy: a prospective study. Am J Roentgenol. 2010; https://doi.org/10.2214/AJR.09.2988.

  44. Errico TJ, et al. “MRI of cervical and lumbar spine disorders.” Spinal Disorders and Treatment the NYU-HJD Comprehensive Textbook, Jaypee, New Delhi U.a., 2015, pp. 102–107.

    Google Scholar 

  45. Wolfer LR, Derby R, Lee JE, Lee SH. Systematic review of lumbar provocation discography in asymptomatic subjects with a meta-analysis of false-positive rates. Pain Physician. 2008; https://doi.org/10.36076/ppj.2008/11/513.

  46. Carragee EJ, Tanner CM, Yang B, Brito JL, Truong T. False-positive findings on lumbar discography. Spine (Phila Pa 1976). 1999; https://doi.org/10.1097/00007632-199912010-00017.

  47. Walsh TR, Weinstein JN, Spratt KF, Lehmann TR, Aprill C, Sayre H. Lumbar discography in normal subjects. A controlled, prospective study. J Bone Jt Surg Ser A. 1990; https://doi.org/10.2106/00004623-199072070-00019.

  48. Carragee EJ, Tanner CM, Khurana S, et al. The rates of false-positive lumbar discography in select patients without low back symptoms. Spine (Phila Pa 1976). 2000; https://doi.org/10.1097/00007632-200006010-00009.

  49. Carragee EJ, Alamin TF, Miller J, Grafe M. Provocative discography in volunteer subjects with mild persistent low back pain. Spine J. 2002; https://doi.org/10.1016/S1529-9430(01)00152-8.

  50. Chelala L, Trent G, Waldrop G, Dagher AP, Reinig JW. Positive predictive values of lumbar spine magnetic resonance imaging findings for provocative discography. J Comput Assist Tomogr. 2019; https://doi.org/10.1097/RCT.0000000000000885.

  51. Errico TJ, et al. “Interventional diagnostic procedures: nerve blocks and discography.” Spinal Disorders and Treatment the NYU-HJD Comprehensive Textbook, Jaypee, New Delhi U.a., 2015, pp.121.

    Google Scholar 

  52. Roelofs PDDM, Deyo RA, Koes BW, Scholten RJPM, Van Tulder MW. Nonsteroidal anti-inflammatory drugs for low back pain: an updated cochrane review. Spine (Phila Pa 1976). 2008; https://doi.org/10.1097/BRS.0b013e31817e69d3.

  53. Morlion B. Pharmacotherapy of low back pain: targeting nociceptive and neuropathic pain components. Curr Med Res Opin. 2011; https://doi.org/10.1185/03007995.2010.534446.

  54. Steinmetz MP, Benzel EC. Benzel’s spine surgery : techniques, complication avoidance, and management Fourth Edition.; 2016.

    Google Scholar 

  55. Salerno SM, Browning R, Jackson JL. The effect of antidepressant treatment on chronic back pain: a meta-analysis. Arch Intern Med. 2002; https://doi.org/10.1001/archinte.162.1.19.

  56. Cifuentes M, Webster B, Genevay S, Pransky G. The course of opioid prescribing for a new episode of disabling low back pain: opioid features and dose escalation. Pain. 2010; https://doi.org/10.1016/j.pain.2010.04.012.

  57. Errico TJ, et al. “Pharmacologic management of spinal pain: non-narcotics.” Spinal Disorders and Treatment the NYU-HJD Comprehensive Textbook, Jaypee, New Delhi U.a., 2015, pp. 147–150.

    Google Scholar 

  58. Kassis A. Antidepressants to treat nonspecific low back pain. Am Fam Physician. 2008;

    Google Scholar 

  59. Savigny P, Watson P, Underwood M. Guidelines—early management of persistent non-specific low back pain: summary of NICE guidance. BMJ. 2009; https://doi.org/10.1136/bmj.b1805.

  60. Manchikanti L. Medicare in interventional pain management: a critical analysis. Pain Physician. 2006;

    Google Scholar 

  61. Cuckler JM, Bernini PA, Wiesel SW, Booth RE, Rothman RH, Pickens GT. The use of epidural steroids in the treatment of lumbar radicular pain. J Bone Jt Surg Ser A. 1985; https://doi.org/10.2106/00004623-198567010-00009.

  62. Buttermann GR. Treatment of lumbar disc herniation: epidural steroid injection compared with discectomy: a prospective, randomized study. J Bone Jt Surg Ser A. 2004; https://doi.org/10.2106/00004623-200404000-00002.

  63. Longo UG, Petrillo S, Franceschetti E, Berton A, Maffulli N, Denaro V. Stem cells and gene therapy for cartilage repair. Stem Cells Int. 2012; https://doi.org/10.1155/2012/168385.

  64. Errico TJ, et al. “Basic science of degenerative disk disease.” Spinal Disorders and Treatment the NYU-HJD Comprehensive Textbook, Jaypee, New Delhi U.a., 2015, pp. 3–10.

    Google Scholar 

  65. Yue JJ, Bertagnoli R, McAfee PC, An HS. Motion preservation surgery of the spine: advanced techniques and controversies. Am J Neuroradiol. 2009; https://doi.org/10.3174/ajnr.a1707.

  66. Zmurko MG, Tannoury TY, Tannoury CA, Anderson DG. Cervical sprains, disc herniations, minor fractures, and other cervical injuries in the athlete. Clin Sports Med. 2003; https://doi.org/10.1016/S0278-5919(03)00003-6.

  67. Matz PG, Anderson PA, Holly LT, et al. The natural history of cervical spondylotic myelopathy. J Neurosurg Spine. 2009; https://doi.org/10.3171/2009.1.SPINE08716.

  68. Errico TJ, et al. “Operative management of degenerative cervical disorders.” Spinal Disorders and Treatment the NYU-HJD Comprehensive Textbook, Jaypee, New Delhi U.a., 2015, pp. 324–330.

    Google Scholar 

  69. Bertalanffy H, Eggert HR. Clinical long-term results of anterior discectomy without fusion for treatment of cervical radiculopathy and myelopathy—a follow-up of 164 cases. Acta Neurochir. 1988; https://doi.org/10.1007/BF01560567.

  70. Decker RC. Surgical treatment and outcomes of cervical radiculopathy. Phys Med Rehabil Clin N Am. 2011; https://doi.org/10.1016/j.pmr.2010.12.001.

  71. Pickett GE, Sekhon LHS, Sears WR, Duggal N. Complications with cervical arthroplasty. J Neurosurg Spine. 2006; https://doi.org/10.3171/spi.2006.4.2.98.

  72. Errico TJ, et al. “Cervical total disk replacement.” Spinal Disorders and Treatment the NYU-HJD Comprehensive Textbook, Jaypee, New Delhi U.a., 2015, pp. 347,349.

    Google Scholar 

  73. Errico TJ, et al. “Newer motion preservation technologies.” Spinal Disorders and Treatment the NYU-HJD Comprehensive Textbook, Jaypee, New Delhi U.a., 2015, pp. 332–335.

    Google Scholar 

  74. Kondrashov DG, Hannibal M, Hsu KY, Zucherman JF. Interspinous process decompression with the X-STOP device for lumbar spinal stenosis: a 4-year follow-up study. J Spinal Disord Tech. 2006; https://doi.org/10.1097/01.bsd.0000211294.67508.3b.

  75. Verhoof OJ, Bron JL, Wapstra FH, Van Royen BJ. High failure rate of the interspinous distraction device (X-Stop) for the treatment of lumbar spinal stenosis caused by degenerative spondylolisthesis. Eur Spine J. 2008; https://doi.org/10.1007/s00586-007-0492-x.

  76. Xu C, Ni WF, Tian NF, Hu XQ, Li F, Xu HZ. Complications in degenerative lumbar disease treated with a dynamic interspinous spacer (Coflex). Int Orthop. 2013; https://doi.org/10.1007/s00264-013-2006-2.

  77. Bono CM, Kadaba M, Vaccaro AR. Posterior pedicle fixation-based dynamic stabilization devices for the treatment of degenerative diseases of the lumbar spine. J Spinal Disord Tech. 2009; https://doi.org/10.1097/BSD.0b013e31817c6489.

  78. Sengupta DK, Herkowitz HN. Pedicle screw-based posterior dynamic stabilization: literature review. Adv Orthop. 2012; https://doi.org/10.1155/2012/424268.

Download references

Author information

Authors and Affiliations

  1. Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Caroline Varlotta

Authors
  1. Caroline Varlotta
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Physical Medicine and Rehabilitation, Mount Sinai Hospital, New York, NY, USA

    Michael Harbus

  2. Princeton Spine and Joint Center, Princeton, NJ, USA

    Grant Cooper

  3. Department of Rehabilitation Medicine, Mount Sinai Hospital, New York, NY, USA

    Joseph E. Herrera

  4. Princeton Spine and Joint Center, Princeton, NJ, USA

    Zinovy Meyler

  5. Princeton Spine and Joint Center, Princeton, NJ, USA

    Marco Funiciello

Rights and permissions

Reprints and permissions

Copyright information

© 2022 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Varlotta, C. (2022). Discogenic Pain. In: Harbus, M., Cooper, G., Herrera, J.E., Meyler, Z., Funiciello, M. (eds) A Case-Based Approach to Neck Pain. Springer, Cham. https://doi.org/10.1007/978-3-031-17308-0_4

Download citation

  • DOI: https://doi.org/10.1007/978-3-031-17308-0_4

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-17307-3

  • Online ISBN: 978-3-031-17308-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation