Contents

Search

lumbar disc disease

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: 1) ruptured or herniated disc - pain - abnormal posture - limitation of spine movement - radicular pain (sciatica) 2) no disc herniation a) back pain - frequent episodes of severe, but brief pain - episodes precipitated by sudden movements of spine b) leg pain (sciatica) c) no signs of nerve root involvement 3) lumbar spinal stenosis - pain with standing & walking, relieved by sitting, bending foward - pain takes several minutes to resolve when induced by walking - pain is relieved by spinal flexion - pain is aggravated by extension of the spine - wide-based gait - neuromuscular deficits of the lower extremity - weakness of L4-S1 innervated muscles - hallux extensors, hip abductors, hip extensors Differential diagnosis: - sacral fracture, especially sacral insufficiency fracture - lumbar spinal stenosis (see Clinical manifestations above) - sciatica Management: 1) 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 2) 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]

Related

cauda equina syndrome herniated disc low back pain (LBP)

General

disc disease

Database Correlations

OMIM 603932

References

  1. Harrison's Principles of Internal Medicine, 14th ed. Fauci et al (eds), McGraw-Hill Inc. NY, 1998, pg 77
  2. UCLA Intensive Course in Geriatric Medicine & Board Review, Marina Del Ray, CA, Sept 12-15, 2001
  3. 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: 22287295
  4. 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: 21102279
  5. 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. PMID: 28319997 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. PMID: 28319999 http://annals.org/aim/article/2612725/challenges-research-interventions-low-back-pain