Discogenic Back Pain

  • This is known as hard or “dark” disc disease
  • There is degeneration of lumbar disc, leading to back pain without evidence of neural compression
  • X-rays show disc space narrowing. MRI shows degenerate discs (i.e. ↓ signal on T2 weighted images)
  • If there is no response to NSAIDs, conditioning & activity modification discograms can be performed
    • degenerate levels, plus one or two normal levels, are injected
  • Injection of degenerate discs should provoke pain; injection of normal discs should be painless
  • In presence of such findings & ongoing pain it is possible to perform interbody fusion
Discogenic Back Pain, sagittal t2 weighted mri of the lumbar spine
Sagittal T2 weighted MRI of the lumbar spine. Image by Ptrump16, Wikimedia Commons, CC BY-SA 4.0.

Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.