Discogenic low back pain is a complex, multi-factorial, clinical condition. It is characterized by low back pain, with or without the concurrence of radicular lower limb symptoms, in the presence of radiologically-confirmed degenerative disc disease.
Magnetic resonance imaging is the imaging study of choice for degenerative disk disease due to its unique detail on the representation of the disk status. Other tests may include plain radiographs, computed tomography scanning, or provocative discography.
Nonsurgical treatments include lifestyle measures, followed by the judicious use of medications, physical therapy, and therapeutic needling procedures.
Surgical treatment includes decompression of neural structures and, in selected patients, a fusion of the motion segment.
A complex, multifactorial, clinical condition characterized by low back pain with or without the concurrence of radicular lower limb symptoms in the presence of radiologically-confirmed degenerative disk disease. The pain is exacerbated by activity, but may be present in certain positions, such as sitting.
Progression of disk degeneration may lead to additional painful manifestations, including loss of disk height and facet joint arthrosis, disk herniation and nerve root irritation, and hypertrophic changes resulting in spinal stenosis.
History and exam
Key diagnostic factors
- persistent low back pain
- radicular leg pain
- activity-related symptoms
Other diagnostic factors
- restriction in lumbar motion
- positive straight leg raise
- neurological deficit (leg weakness, sensory loss, bladder and bowel symptoms)
- 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
- diabetes mellitus
1st investigations to order
- erect lumbar spine x-ray
- MRI spine
Investigations to consider
- CT spine
- flexion/extension spine x-rays
- single photon emission computed tomography
- CT myelogram
- MRI with gadolinium (contrast)
- genetic testing
- functional spinal imaging
neurological emergency (nerve root deficit or cauda equina syndrome)
acute back pain: <3 months duration from initial presentation or exacerbation of chronic pain
chronic back pain: ≥3 months duration from initial presentation
Jwalant S. Mehta, MBBS, MS(Orth), D(Orth), MCh(Orth), FRCS(Orth)
Consultant Spine Surgeon
Royal Orthopaedic Hospital
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.
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.
Jayesh Trivedi, FRCS (Orth)
Consultant Spine Surgeon and Head of Department
Centre for Spinal Studies
Robert Jones and Agnes Hunt Hospital NHS Foundation Trust
Alder Hey University Children's Hospital
JT declares that he has no competing interests.
John Ratliff, MD, FAANS, FACS
Department of Neurosurgery
JR declares that he has no competing interests.
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