lumbar disc disease
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Introduction
Common cause of chronic or recurrent low back pain & leg pain. Most common locations L4-L5 & L5-S1. Severe disc disease can result in herniation. Lumbar disc disease is generally unilateral.
Etiology
- increased BMI increases risk[3]
Genetics
- defects in CILP gene may be a cause of susceptibility to lumbar disc disease
- susceptibility to intervertebral disc disease & lumbar disk herniation may be associated with defects in COL9A2, COL9A3
Clinical manifestations
- ruptured or herniated disc
- pain
- abnormal posture
- limitation of spine movement
- radicular pain (sciatica)
- no disc herniation
- back pain
- frequent episodes of severe, but brief pain
- episodes precipitated by sudden movements of spine
- leg pain (sciatica)
- no signs of nerve root involvement
- back pain
- lumbar spinal stenosis
- pain with standing & walking, relieved by sitting, bending foward
- wide-based gait
- neuromuscular deficits of the lower extremity
- weakness of L4-S1 innervated muscles
Differential diagnosis
- sacral fracture, especially sacral insufficiency fracture
- lumbar spinal stenosis (see Clinical manifestations above)
- sciatica
Management
- Surgery:
- indications for disc surgery
- progressive motor weakness from nerve root injury
- progressive impairment demonstrated by EMG & nerve conduction studies
- abnormal bowel or bladder function or other signs of spinal cord disease
- incapacitating nerve root pain despite conservative treatment for >= 4 weeks
- indications for disc surgery
- glucocorticoid injection
- benefit at 1 month in 55% vs 33% of controls
- at 3 months increases in pain reported
- at 12 months, no difference in groups[5]
More general terms
Additional terms
References
- ↑ Harrison's Principles of Internal Medicine, 14th ed. Fauci et al (eds), McGraw-Hill Inc. NY, 1998, pg 77
- ↑ UCLA Intensive Course in Geriatric Medicine & Board Review, Marina Del Ray, CA, Sept 12-15, 2001
- ↑ 3.0 3.1 Samartzis D et al. The association of lumbar intervertebral disc degeneration on magnetic resonance imaging with body mass index in overweight and obese adults: A population-based study. Arthritis Rheum 2012 May; 64:1488 PMID: https://www.ncbi.nlm.nih.gov/pubmed/22287295
- ↑ Kabir SM1, Gupta SR, Casey AT. Lumbar interspinous spacers: a systematic review of clinical and biomechanical evidence. Spine (Phila Pa 1976). 2010 Dec 1;35(25):E1499-506 PMID: https://www.ncbi.nlm.nih.gov/pubmed/21102279
- ↑ 5.0 5.1 Nguyen C, Boutron I, Baron G et al Intradiscal Glucocorticoid Injection for Patients With Chronic Low Back Pain Associated With Active Discopathy: A Randomized Trial. Ann Intern Med. 2017. March 21. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28319997 <Internet> http://annals.org/aim/article/2612231/intradiscal-glucocorticoid-injection-patients-chronic-low-back-pain-associated-active
Kennedy DJ, Schneider BJ The Challenges of Research on Interventions for Low Back Pain. Trial. Ann Intern Med. 2017. March 21. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28319999 <Internet> http://annals.org/aim/article/2612725/challenges-research-interventions-low-back-pain