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
- Spinal tumor
- Spinal infection
- Postural back pain
- CDC prescribing opioids for pain
- ACR appropriateness criteria: low back pain
Back pain (lower back)
Back pain: questions to ask your doctorMore Patient leaflets
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