Lorio Morgan P, Beall Douglas P, Myers Thomas J, Naidu Ramana K, McRoberts W Porter, Davis Timothy T, Gage Emmanuel G, Calodney Aaron K, Verrills Paul, De Palma Michael J, Amirdelfan Kasra, Block Jon E
Orlando College of Osteopathic Medicine, Winter Garden, FL, USA.
Comprehensive Specialty Care, Edmond, OK, USA.
J Pain Res. 2025 Jul 1;18:3331-3343. doi: 10.2147/JPR.S522750. eCollection 2025.
There is renewed interest in the intervertebral disc as a target for treatments aimed at ameliorating lumbar discogenic pain by restoring and preserving the natural structure and function of this component of the vertebral motion segment.
Using a modified Delphi methodology involving a panel of 11 experts, we developed a simple, understandable clinical algorithm to serve as a foundation for objective decision making regarding the diagnosis and treatment of lumbar discogenic pain throughout the entire continuum of care. A decision tree approach was utilized with "either/or" choices at each branch or node in the algorithm. Clinical activities in this algorithm were divided into examination procedures and corresponding treatment interventions. Corresponding treatment options were designated based on published degenerative disc disease (DDD)-specific clinical practice guidelines and/or meta-analyses.
This algorithm recommends a systematic rule set for discogenic pain diagnostic and treatment options. Initially, the presence of lumbar discogenic pain is confirmed via assessment of a series of clinical signs including axial midline back pain (≥ 4 of 10), pain with flexion, sitting intolerance, positive pain provocation with sustained hip flexion, and absence of motor/sensory/reflex changes. Radiographic severity of DDD is graded by modified Pfirrmann grade (1 to 8). Treatment options are stratified by DDD severity to include conservative management (grades 1 and 2), minimally-invasive intradiscal therapies (grades 3 to 7), and more invasive surgical procedures (grade 8). Recognizing that the management program for patients with lumbar discogenic pain can be highly personalized, the treatment options recommended by this algorithm should be considered general guidance.
The proposed algorithm offers an easy-to-use clinical tool for identifying, evaluating and treating patients with lumbar discogenic pain. The successful implementation of this algorithm involves an important interplay between advanced practice providers, interventional pain physicians and spine surgeons.
人们对椎间盘作为治疗靶点重新产生了兴趣，这些治疗旨在通过恢复和保留椎骨运动节段这一组成部分的自然结构和功能来缓解腰椎间盘源性疼痛。
我们采用改良的德尔菲法，邀请了11位专家组成小组，制定了一个简单易懂的临床算法，作为在整个连续护理过程中对腰椎间盘源性疼痛进行诊断和治疗的客观决策基础。该算法采用决策树方法，在每个分支或节点处设置“二选一”的选择。此算法中的临床活动分为检查程序和相应的治疗干预措施。根据已发表的针对退行性椎间盘疾病（DDD）的临床实践指南和/或荟萃分析指定相应的治疗方案。
该算法推荐了一套用于椎间盘源性疼痛诊断和治疗方案的系统规则集。首先，通过评估一系列临床体征来确认腰椎间盘源性疼痛的存在，这些体征包括轴向中线背痛（10分制中≥4分）、屈曲时疼痛、不耐久坐、持续髋关节屈曲时疼痛激发试验阳性以及无运动/感觉/反射改变。DDD的影像学严重程度采用改良的Pfirrmann分级（1至8级）。治疗方案根据DDD严重程度分层，包括保守治疗（1级和2级）、微创椎间盘内治疗（3至7级）以及更具侵入性的外科手术（8级）。认识到腰椎间盘源性疼痛患者的管理方案可能高度个体化，该算法推荐的治疗方案应被视为一般指导。
所提出的算法为识别、评估和治疗腰椎间盘源性疼痛患者提供了一种易于使用的临床工具。该算法的成功实施涉及高级执业提供者、介入疼痛科医生和脊柱外科医生之间的重要相互作用。
