BACKGROUND: Chronic axial low back pain is often multifactorial, involving overlapping facetogenic, discogenic and vertebrogenic pain generators. Although several treatment modalities exist for clear-cut cases in which the primary pain generator is well defined, optimal management for patients with mixed pathology remains unclear.

CASE REPORT: In this case, a 27-year-old man presented with refractory axial low back pain and severely limited range of motion associated with Modic type 1 endplate changes and discogenic pain at L3–4 and L5–S1 confirmed by provocative discography. After transient benefit from basivertebral nerve ablation and minimal response to medial branch blocks, the patient underwent a multimodal treatment intervention, consisting of subchondral vertebral endplate bone marrow aspirate concentrate (BMAC) injections at L3–4, intradiscal BMAC injection at L5–S1, and lumbar disc arthroplasty at L3–4. Pain improved from 6/10 in severity pre-intervention to 1–2/10 in severity, with a 75% increase in lumbar range of motion at 4 months post-intervention.

CONCLUSIONS: This case presents an innovative, motion-preserving restorative treatment approach for multifactorial axial low back pain, combining targeted BMAC injections to the subchondral vertebral endplates and intervertebral disc with disc arthroplasty.

KEYWORDS: Modic changes, Subchondral BMAC injections, case report, disc arthroplasty, discogenic pain