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To better instruct the clinical treatment of discogenic low back pain,a prospective clinical study was performed to observe the natural history of the disease.A total of 279 patients with chronic low back pain were included between June 2006 and October 2007.One hundred and fifty-six(55.9%)were proved to be discogenic back pain using discography.A 101-point numerical rating scale(NRS-101)and Oswestry Disability Index(ODI)were used to assess the back pain symptoms and the lumbar function respectively.Of the 156 patients,131(84%)completed the study of 4-year follow-up.At the end of follow-up,17 cases(13.0%)had their low back pain symptom alleviated and lumbar function improved,10 cases(7.6%)slightly improved,16 cases(12.2%)aggravated,and 88 cases(67.2%)experienced the same pain and disability as before.Although the average NRS and ODI scores obtained during the 4-year follow-up study gradually decreased,statistical significances were found in such changes(P < 0.05,and P < 0.05,respectively),however,the improvement rates of both pain and disability(7.6%,and 5.2%respectively)were very low.Our study indicated that the natural history of discogenic low back pain was chronic but persistent,and that the pain and disability in most patients did not improve over time.The elucidation of natural history of discogenic low back pain has important clinical significances for decision-making of treatments.When nonsurgical treatments fail,fusion surgery or artificial disc replacement may have to be considered on highly selected patients,with the aim of reducing pain and decreasing disability.