summary Discogenic back pain is a common etiology of axial low back pain without radicular symptoms and is caused by intervertebral disc degeneration Diagnosis is made by a combination of history, physical examination, and MRI Treatment is usually NSAIDs, physical therapy, cognitive therapy, and lifestyle modifications Etiology Mechanism disc characteristics are modified by bone morphogenetic proteins Presentation Symptoms axial low back pain without radicular symptoms pain exacerbated by: bending sitting axial loading Physical exam nerve tension (straight leg raise) signs negative Imaging Radiographs first diagnostic study to evaluate for disc degeneration MRI identifies degenerative discs without significant stenosis or herniation Provocative discography criteria for a positive test: concordant pain response abnormal disc morphology on fluoroscopy and post-discography CT negative control levels in the lumbar spine outcomes studies have shown that provocative discography leads to accelerated disc degeneration, including: login to view 3 more bullets Treatment Nonoperative NSAIDs, physical therapy, cognitive therapy, and lifestyle modifications indications login to view 1 more bullet outcomes login to view 1 more bullet Operative lumbar discectomy with fusion indications login to view 1 more bullet outcomes login to view 1 more bullet lumbar total disc replacement indications login to view 2 more bullets outcomes login to view 2 more bullets complications login to view 5 more bullets