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What are the pathogenesis, diagnosis, and treatment of internal disc disruption (IDD)?
IDD may begin as a vertebral endplate fracture caused by chronic repetitive or acute strain leading to annular tears of varying degrees. Nerve endings may grow into the inner annulus and become sensitized by chemicals leaking from the nucleus pulposus via the tears. Clinically, there is a band-like axial back pain. MRI may be helpful in diagno-sis but a provocative discogram correlating radiologic and clinical findings may be more specific and sensitive.
Treatment modalities include intra-discal electro-thermocoagulation (IDET) and spinal fusion, if there is instability. Several theories have been proposed as to the mechanism of action of IDET. It may denervate the nerve supply to the disc, denature the chemical mediators of sensitization, or possibly coagulate the collagen in the disc to close the tear.
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