Pathomechanisms of discogenic low back pain in humans and animal models

Spine J. 2015 Jun 1;15(6):1347-55. doi: 10.1016/j.spinee.2013.07.490. Epub 2014 Mar 20.


Background context: Although explored in humans and animal models, the pathomechanisms of discogenic low back pain (LBP) remain unknown.

Purpose: The aim of this study was to review the literature about the pathomechanisms of discogenic LBP.

Methods: Animal models of discogenic pain and specimens from degenerated human intervertebral discs (IVDs) have provided clues about the pathomechanisms of discogenic LBP. Painful discs are characterized by a confluence of innervation, inflammation, and mechanical hypermobility. These three possible mechanisms are discussed in this review.

Results: Animal models and specimens from humans have revealed sensory innervation of lumbar IVDs and sensory nerve ingrowth into the inner layer of IVDs. Cytokines such as tumor necrosis factor-α and interleukins induce this ingrowth. Nerve growth factor has also been recently identified as an inducer of ingrowth. Finally, disc degeneration induces several collagenases; their action results in hypermobility and pain.

Conclusions: To treat discogenic LBP, it is important to prevent sensitization of sensory nerve fibers innervating the IVD, to suppress pathogenic increases of cytokines, and to decrease disc hypermobility.

Keywords: Hypermobility; Inflammation; Intervertebral disc; Pain; Psychosocial factors; Sensory nerve.

Publication types

  • Review

MeSH terms

  • Animals
  • Cytokines / metabolism
  • Disease Models, Animal
  • Humans
  • Intervertebral Disc / metabolism
  • Intervertebral Disc / pathology*
  • Intervertebral Disc Degeneration / complications
  • Intervertebral Disc Degeneration / pathology*
  • Low Back Pain / etiology
  • Low Back Pain / pathology*
  • Nerve Growth Factor / metabolism


  • Cytokines
  • Nerve Growth Factor