Lombalgia discogênica
Summary
Definition
History and exam
Key diagnostic factors
- lombalgia persistente
- dor radicular nas pernas
- sintomas relacionados à atividade
Other diagnostic factors
- restrição no movimento lombar
- elevação da perna em linha reta positiva
- deficit neurológico (fraqueza nas pernas, perda sensorial, sintomas vesicais e intestinais)
Risk factors
- idade mais avançada
- influência genética
- ocupação (cargas axiais excessivas, vibrações decorrentes de transporte)
- tabagismo
- tropismo de facetas articulares e artrite
- morfologia pélvica anormal
- alterações no alinhamento sagital
- obesidade
- diabetes mellitus
- aterosclerose
Diagnostic tests
1st tests to order
- radiografia da coluna lombar em posição ortostática
- RNM da coluna vertebral
Tests to consider
- tomografia computadorizada (TC) da coluna vertebral
- radiografias de flexão/extensão da coluna vertebral
- tomografia computadorizada por emissão de fóton único
- mielografia por tomografia computadorizada (TC)
- discografia
- RNM com gadolínio (contraste)
Emerging tests
- teste genético
- exames de imagem funcionais da coluna vertebral
Treatment algorithm
emergência neurológica (deficiência da raiz nervosa ou síndrome da cauda equina)
dorsalgia aguda: intervalo <3 meses desde a apresentação inicial ou exacerbação de dor crônica
dorsalgia crônica: intervalo ≥3 meses desde a apresentação inicial
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, 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
Disclosures
JR declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
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. Abstract
National Institute for Health and Care Excellence. Low back pain and sciatica in over 16s: assessment and management. Dec 2020 [internet publication].Full text
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.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Tumor da medula espinhal
- Infecção da coluna vertebral
- Dorsalgia postural
More DifferentialsGuidelines
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- ACR appropriateness criteria: low back pain
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