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Discogenic low back pain

Last reviewed: 28 Oct 2023
Last updated: 16 Dec 2022



History and exam

Key diagnostic factors

  • persistent low back pain
  • radicular leg pain
  • activity-related symptoms
More key diagnostic factors

Other diagnostic factors

  • restriction in lumbar motion
  • positive straight leg raise
  • neurological deficit (leg weakness, sensory loss, bladder and bowel symptoms)
Other diagnostic factors

Risk factors

  • increasing age
  • genetic influence
  • occupation (excessive axial loads, vibrations from transportation)
  • tobacco smoking
  • facet joint tropism and arthritis
  • abnormal pelvic morphology
  • changes in sagittal alignment
  • obesity
  • diabetes mellitus
  • atherosclerosis
More risk factors

Diagnostic investigations

1st investigations to order

  • erect lumbar spine x-ray
  • MRI spine
More 1st investigations to order

Investigations to consider

  • CT spine
  • flexion/extension spine x-rays
  • single photon emission computed tomography
  • CT myelogram
  • discography
  • MRI with gadolinium (contrast)
More investigations to consider

Emerging tests

  • genetic testing
  • functional spinal imaging

Treatment algorithm


neurological emergency (nerve root deficit or cauda equina syndrome)


acute back pain: <3 months duration from initial presentation or exacerbation of chronic pain


chronic back pain: ≥3 months duration from initial presentation



Jwalant S. Mehta, MBBS, MS(Orth), D(Orth), MCh(Orth), FRCS(Orth)

Consultant Spine Surgeon

Royal Orthopaedic Hospital




JSM declares that he has received research support from Stryker K2M, Depuy Synthes and Nuvasive; is a speaker for AO Spine and Scoliosis Research Society; serves on the editorial board for the European Spine Journal, the Spine Deformity Journal, and the Bone Joint Journal, is a reviewer for the Global Spinal Journal, and is part of the Paediatric Spine Study Group.


Dr Jwalant S. Mehta would like to gratefully acknowledge Dr Giannoulis Kyriakos and Dr Nasir Quiraishi, previous contributors to this topic. GK and NQ declare that they have no competing interests.

Peer reviewers

Jayesh Trivedi, FRCS (Orth)

Consultant Spine Surgeon and Head of Department

Centre for Spinal Studies

Robert Jones and Agnes Hunt Hospital NHS Foundation Trust


Alder Hey University Children's Hospital




JT declares that he has no competing interests.

John Ratliff, MD, FAANS, FACS

Associate Professor

Department of Neurosurgery

Stanford University




JR declares that he has no competing interests.

  • Discogenic low back pain images
  • Differentials

    • Spinal tumor
    • Spinal infection
    • Postural back pain
    More Differentials
  • Guidelines

    • CDC prescribing opioids for pain
    • ACR appropriateness criteria: low back pain
    More Guidelines
  • Patient leaflets

    Back pain (lower back)

    Back pain: questions to ask your doctor

    More Patient leaflets
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