Internal disc disruption associated with axial back pain but not radicular pain is a disease entity that was recognized about two decades ago as a disorder that could potentially be treated by spinal fusion. In this article the authors describe the clinical syndrome, magnetic resonance imaging and discography findings of pathophysiological pain generation, and the available surgical options. Based on the current understanding of this disease entity, the optimum surgical procedure entails radical discectomy, anterior column support, adequate amounts of auto- or allograft bone, bone extenders and enhancers, and rigid stabilization of the motion segment.
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