Purpose of Review

Many studies have demonstrated that discogenic low back pain is the most common type of chronic low back pain (CLBP), one of the major causes of disability, and has a major socioeconomic impact. Our aim is to review present therapeutic interventions for discogenic low back pain.

Recent Findings

There are a multitude of treatments used in clinical practice to treat CLBP, but there is continued debate and lack of consensus among clinicians and the policy makers as to which modality is the best approach. Based on controlled evaluations, lumbar intervertebral discs have been shown to be the source of chronic back pain without disc herniation in 26 to 39% of patients. Treatment modalities include noninvasive treatments such as drug therapy, multiple physical modalities, and multidisciplinary biopsychosocial rehabilitation; interventional modalities such as intradiscal therapies and epidural injections; and regenerative modalities with disc injections of various solutions; and, finally, surgical approaches such as fusion and artificial disc replacement, all of which are accompanied by significant discussion, limited evidence, and lack of consensus.

Summary

The results of this evaluation show that the evidence for drug therapy in chronic discogenic low back pain is limited; for multidisciplinary biopsychosocial rehabilitation, it is moderate; and for multiple physical and behavioral therapies, the evidence is limited. For intradiscal therapies, it is poor; for epidural injections, it is moderate; and for regenerative therapies, evidence levels of 3 to 4. The evidence for surgical fusions and disc replacement is similar, without superiority when compared with multidisciplinary biopsychosocial rehabilitation, well-designed physical therapy, or epidural injections.

中文翻译：

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椎间盘源性下腰痛的治疗：当前的治疗策略和未来的选择-文献综述。

审查目的

许多研究表明，椎间盘源性下背痛是慢性下背痛（CLBP）的最常见类型，是导致残疾的主要原因之一，并且对社会经济产生重大影响。我们的目的是回顾目前针对椎间盘源性下腰痛的治疗性干预措施。

最近的发现

临床实践中使用多种治疗CLBP的方法，但临床医生和决策者之间仍在争论哪种方法是最好的方法一直存在争议。根据对照评估，在26％至39％的患者中，腰椎间盘突出是慢性腰背痛而无椎间盘突出的原因。治疗方式包括无创治疗，例如药物治疗，多种物理方式和多学科的生物心理社会康复；介入方式，例如椎间盘内治疗和硬膜外注射；盘式注入各种解决方案的再生方式；最后，手术方法，如融合和人工椎间盘置换，所有这些都伴随着大量讨论，有限证据，

概要

评估结果表明，在慢性椎间盘源性下腰痛中进行药物治疗的证据有限。对于多学科的生物心理社会康复，中等程度；对于多种物理和行为疗法，证据有限。对于椎间盘内治疗，效果很差；对于硬膜外注射，中等。对于再生疗法，证据水平为3至4。与多学科生物心理社会康复，精心设计的物理疗法或硬膜外注射相比，手术融合和椎间盘置换的证据相似，没有优势。