Discogenic lumbar pain due to fibrous ring rupture

In most cases, pain in the lumbar spine is caused by damage to the intervertebral discs (IVD), facet joints and/or sacroiliac joints and in these cases is regarded as non-specific lumbar pain (NLP). The pathogenetic basis of axial discogenic pain (DP) is inflammation and ingrowth of nerve fibers into the structure of IVD. DP is confirmed by the positive effect of epidural administration of local anesthetics and glucocorticoids. One of the little-known DP variants is the rupture of a fibrous ring (RFR), which is detected by magnetic resonance imaging in the T2 weighted mode as a zone with high signal intensity in the posterior segments of a fibrous ring. The recommended first-line treatment for NLP is patient's education, tips for maintaining activity, physiotherapy exercises and manual therapy. For the drug therapy nonsteroidal anti-inflammatory drugs (NSAIDs) and muscle relaxers are used. We describe two clinical observations of patients with NLP with RFR. Educational program, Aertal as NSAID and Mydocalm Long as muscle relaxer were effective in terms of therapy. The issues of optimization of treatment of patients with NLP are discussed.