Episode # 67 • 04 Feb 2025
Introduction to Treatment of Discogenic Back Pain
Degenerative disc disease, a major cause of low back pain, is the most common musculoskeletal issue worldwide, affecting an estimated 15-30% of the population. In this episode of BackTable MSK, interventional radiologists Dr. Olivier Clerk-Lamalice and Dr. Jacob Fleming cover symptomatic degenerative disc disease, focusing on its diagnosis and treatment with anesthetic injections. This is the first episode in a two-part series on discogenic back pain.
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Timestamps
00:00 - Introduction
02:44 - Pathophysiology of Disc Degeneration
06:49 - Evolution of Discography
12:55 - Classification of Annular Tears
09:01 - Diagnostic Tools and Techniques
14:00 - CT Discogram and Annular Tear Classification
17:12 - Dynamic Aspects and Instability
22:20 - Identifying Symptomatic Disc Level
28:25 - Treatment Approaches and Patient Selection
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More about this episode
Dr. Clerk-Lamalice begins by explaining the pathophysiology of disc degeneration, which can lead to painful annular tears and loss of disc height. The doctors also reflect on the history of discography, from provocative discograms to the more recent anesthetic and CT discograms. They review the modified Dallas Discogram Classification for annular tears, the vacuum disc phenomenon, and the importance of dynamic imaging to assess treatment candidacy. Dr. Clerk-Lamalice emphasizes the need to correlate imaging with physical examination to better identify the symptomatic disc level.
The episode also discusses the challenges of managing multi-level disc degeneration and underscores the importance of early-stage intervention.
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