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Discogenic low back pain

Last reviewed: 14 Sep 2025
Last updated: 16 Dec 2022

Summary

Definição

História e exame físico

Principais fatores diagnósticos

  • persistent low back pain
  • radicular leg pain
  • activity-related symptoms
Detalhes completos

Outros fatores diagnósticos

  • restriction in lumbar motion
  • positive straight leg raise
  • neurological deficit (leg weakness, sensory loss, bladder and bowel symptoms)
Detalhes completos

Fatores de risco

  • increasing age
  • genetic influence
  • occupation (excessive axial loads, vibrations from transportation)
  • tobacco smoking
  • facet joint tropism and arthritis
  • abnormal pelvic morphology
  • changes in sagittal alignment
  • obesity
  • diabetes mellitus
  • atherosclerosis
Detalhes completos

Investigações diagnósticas

Primeiras investigações a serem solicitadas

  • erect lumbar spine x-ray
  • MRI spine
Detalhes completos

Tests to avoid

  • dermatomal somatosensory evoked potentials
  • nerve conduction studies
Detalhes completos

Investigações a serem consideradas

  • CT spine
  • flexion/extension spine x-rays
  • single photon emission computed tomography
  • CT myelogram
  • discography
  • MRI with gadolinium (contrast)
Detalhes completos

Algoritmo de tratamento

Inicial

neurological emergency (nerve root deficit or cauda equina syndrome)

AGUDA

acute back pain: <3 months duration from initial presentation or exacerbation of chronic pain

CONTÍNUA

chronic back pain: ≥3 months duration from initial presentation

Colaboradores

Autores

Jwalant S. Mehta, MBBS, MS(Orth), D(Orth), MCh(Orth), FRCS(Orth)

Consultant Spine Surgeon

Royal Orthopaedic Hospital

Birmingham

UK

Disclosures

JSM declares that he has received research support from Stryker K2M, Depuy Synthes and Nuvasive; is a speaker for AO Spine and Scoliosis Research Society; serves on the editorial board for the European Spine Journal, the Spine Deformity Journal, and the Bone Joint Journal, is a reviewer for the Global Spinal Journal, and is part of the Paediatric Spine Study Group.

Acknowledgements

Dr Jwalant S. Mehta would like to gratefully acknowledge Dr Giannoulis Kyriakos and Dr Nasir Quiraishi, previous contributors to this topic. GK and NQ declare that they have no competing interests.

Peer reviewers

Jayesh Trivedi, FRCS (Orth)

Consultant Spine Surgeon and Head of Department

Centre for Spinal Studies

Robert Jones and Agnes Hunt Hospital NHS Foundation Trust

Oswestry

Alder Hey University Children's Hospital

Liverpool

UK

Disclosures

JT declares that he has no competing interests.

John Ratliff, MD, FAANS, FACS

Associate Professor

Department of Neurosurgery

Stanford University

Stanford

CA

Divulgaciones

JR declares that he has no competing interests.

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Referencias

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Artículos principales

Kreiner DS, Hwang SW, Easa JE, et al. An evidence-based clinical guideline for the diagnosis and treatment of lumbar disc herniation with radiculopathy. Spine J. 2014 Jan;14(1):180-91. Resumen

National Institute for Health and Care Excellence. Low back pain and sciatica in over 16s: assessment and management. Dec 2020 [internet publication].Texto completo

Expert Panel on Neurological Imaging, Hutchins TA, Peckham M, et al. ACR Appropriateness Criteria® Low Back Pain: 2021 Update. J Am Coll Radiol. 2021 Nov;18(11s):S361-S379.Texto completo  Resumen

Artículos de referencia

Una lista completa de las fuentes a las que se hace referencia en este tema está disponible para los usuarios con acceso a todo BMJ Best Practice.
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