Overview

Low back pain is a major health concern and the most common reported pain among the U.S. adult population.1 Nearly half of the 220 million adults in the United States experience an episode of low back pain each year. For 10-15% of these people, the pain becomes chronic (lasting longer than 6 months). The economic burden of low back pain is enormous. In 2006, the annual estimated direct healthcare expenditures on patients with back pain the United States reached $100 billion.2
Chronic low back pain can be a complex condition with a multitude of potential sources of the pain. Diagnosis of the cause of the pain is complicated by the fact that a specific diagnosis can only be made in 20% of cases based upon neurological evaluation and imaging studies.3 Conditions diagnosed through these means include intervertebral stenosis, degenerative disc disease, disc herniation or prolapse, spondylothesis, and vertebral compression fractures, among others. Traditional treatments of these conditions, which represent the core of the $3.8 billion orthopedic spine market, include laminectomy, discectomy, fusion and kyphoplasty.4 In recent years, motion preserving technologies such as artificial disc replacement, interspinous spacers and dynamic stabilization technologies have been introduced as alternatives to fusion for some patients with these conditions.


Normal intervertebral disc
anatomy developing painful
internal disc disruptions

For the 80% of patients who cannot be diagnosed through imaging and radiographic studies, other diagnostic procedures must be performed. Researchers have utilized diagnostic nerve blocks and disc provocation studies (discography) to discover that in approximately 40% of these cases, or 4 million patients annually, the back pain is attributable to disruptions of the internal structure within the intervertebral discs.5 This condition, referred to as discogenic pain, currently has no widely accepted therapy other than surgical spinal fusion.

  1. Deyo RA, et al. Back Pain Prevalence and Visit Rates. Spine. 2006; 23:2724-2727.
    2. Katz JN. Lumbar disc disorders and low-back pain: socioeconomic factors and consequences. J Bone Joint Surg Am. 2006;88:21-24.
    3. Bogduk N. Management of Chronic Low Back Pain. MJA. 2004;180:79-83.
    4. Motion Preservation: Innovations in Spinal Implants. First Albany. 2007.
    5. Schwarzer AC, et al. The Prevalence and Clinical Features of Internal Disc Disruption in Patients with Chronic Low Back Pain. Spine. 1995; 20:1878-1883.

Discogenic Pain
An Introduction to Discogenic Chronic Low Back Pain


Normal Intervertebral Disc Anatomy

Intervertebral Disc With Internal
Disc Disruptions

Chronic low back pain affects millions of people every year. The pain can be caused by many different conditions and may originate from many different structures in the back.
The intervertebral discs, which act as shock absorbers between the bones of the human spine, are one of the most common sources of chronic low back pain. Each disc consists of an outer ring, called the anulus fibrosis, and an inner gelatinous region, called the nucleus pulposus. The water-filled nucleus provides the weight bearing function of the discs, while the anulus functions as a retaining ring. Trauma, genetic factors or aging can damage and weaken the anulus. Weakening of the anulus can result in collapse and dehydration of the disc, a condition called Degenerative Disc Disease (DDD). DDD can lead to compression of nearby spinal nerves and result in painful instability of the spine.
In the early stages of disc degeneration, damage to the anulus can cause chronic low back pain without disc collapse and spinal nerve compression. Internal Disc Disruption (IDD) is a condition in which cracks, or fissures, form in the anulus. These fissures create pathways for inflammatory substances concentrated in the disc nucleus to leak onto nerves located in the outer edges of the disc, triggering a “chemical pain” response. Because disc tissues heal very slowly, the anular fissures essentially become painful, chronically inflamed wounds within the disc.
Pain from IDD is mostly located in the lower back, but may also travel down into the legs. The pain associated with IDD is referred to as “discogenic pain” since it originates from the disc itself. Researchers have shown that approximately 40% of chronic low back is caused by IDD. In most instances, discogenic pain is treated with conservative therapies such as bed rest, physical therapy and pain medications. When these treatments are no longer effective, patients may undergo a surgical procedure such as fusion or artificial disc replacement. There are no widely accepted, non-surgical therapies for treating discogenic chronic low back pain.
Spinal Restoration has developed the Biostat® System for use as a new, minimally invasive therapy for discogenic chronic low back pain.
For more information on spinal disorders and the causes of low back pain visit the National Institute of Health website or Spine-health.com.

Treatments

Patients usually attempt to manage their discogenic pain through a variety of nonsurgical and interventional treatments. These measures often include pain medications, exercise programs, physical therapy and spinal injections. While these conservative treatments attempt to manage patients’ pain, they do not directly address the suspected anatomical source of their pain. When these conservative measures fail to provide adequate pain relief, patients are faced with the prospect of a surgical intervention to remove the painful disc. Spinal fusion is the most common surgical treatment for discogenic pain. Alternative surgical procedures, including total disc replacement, nucleus replacement and dynamic stabilization, have recently become available or are currently being studied in clinical trials.
As scientists and physicians have learned more about the origins of discogenic pain, they have begun to research new biologic-based therapies with the goal of helping the body to repair or regenerate the damaged intervertebral disc. Spinal Restoration has developed an investigational biologic product and delivery system, called the Biostat® System, for use in the treatment of discogenic pain. The Biostat System is the first investigational biologic therapy for discogenic pain to enter into a Phase III human clinical study.
To learn more about the Biostat System, please visit our Products page. For more details about our Phase III clinical trial, please visit our Clinical Trials page.

Chronic neck and back pain

Herniated Disk and Sciatica

Pain resulting from auto accidents

Work related pain (including Workers'Compensation)

 Cancer pain

Neuropathic pain

Sympathetic pain syndrome

Phantom limb pain

RSD (Reflex Sympathetic Dystrophy)

SpinalDiagnosticPainManagementCenter

Procedures

Combining IDET with Other Pain Management Treatments

IDET is currently indicated for patients with chronic back pain that does not respond to at least 6 months of conservative treatment. Conservative treatment typically includes a combination of:

  • Medication
  • Rest
  • Activity modification
  • Physical therapy and/or appropriate exercise program

In This Article:

  • IDET: A New Procedure for Discogenic Back Pain Management
  • What Are the Current Indications for IDET?
  • Who Does the IDET Procedure? (Research Article)
  • What is Known About Outcomes for IDET? (Research Article)
  • Research Update on IDET for Pain Management