Discogenic low back pain

Last reviewed: 1 Nov 2022
Last updated: 03 Feb 2022

Summary

Definition

History and exam

Key diagnostic factors

  • persistent low back pain
  • radicular leg pain
  • activity-related symptoms
More key diagnostic factors

Other diagnostic factors

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

Risk factors

  • 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
More risk factors

Diagnostic investigations

1st investigations to order

  • erect lumbar spine x-ray
  • MRI spine
More 1st investigations to order

Investigations to consider

  • CT spine
  • flexion/extension spine x-rays
  • single photon emission computed tomography
  • CT myelogram
  • discography
  • MRI with gadolinium (contrast)
More investigations to consider

Emerging tests

  • genetic testing
  • functional spinal imaging

Treatment algorithm

INITIAL

neurological emergency (nerve root deficit or cauda equina syndrome)

ACUTE

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

ONGOING

chronic back pain: ≥3 months duration from initial presentation

Contributors

Authors

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, Medtronic, and CDMI; 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, and is a reviewer for the Global Spinal Journal.

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

Disclosures

JR declares that he has no competing interests.

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