LUMBAR DISC

Lumbar Disc

Lumbar Disc

Lumbar disc disease

Lumbar disc disease accounts for a large amount of lost productivity in the workforce. Accurate diagnosis can be difficult and often requires interpretation. Treatment is controversial. Surgical treatment can be technically simple and professionally gratifying for the surgeon. Treatment failures are not uncommon, are often related to posttraumatic or work-related injuries, and may result in litigation. As a consequence, this disease can generate distrust of physicians on the part of patients and vice versa.

This article clarifies some important guidelines for the diagnosis and treatment of lumbar disc disease.

Lumbar Disc Disease Overview

Pathogensis

Low back pain is a very common complaint in the aging population. Fortunately, approximately 90% of episodes of low back pain are self-limiting and resolve within approximately six weeks, regardless of treatment.

In most cases of lower back pain, no specific imaging studies or treatment is needed. It is important to first rule out any serious causes of low back pain that need further evaluation by a doctor. "Red flags" (or clues that something more serious could be causing the low back pain) include the following warning signs:

* Age younger than 20 years or older than 50 years

* Major trauma

* History of cancer or recent infection

* Pain worse at night

* Change in bowel or bladder control

* Use of intravenous drugs

* Progressive neurologic deficit or weakness

Along with serious conditions suggested by the above warning signs, there are many other causes of low back pain. In fact, many patients with low back pain are never formally diagnosed with a specific cause.

Epidemiology Of Disease

Lumbar disc disease refers to a collection of degenerative disorders that can lead to low back pain as people age. It is also know as lumbar spondylosis. There are three main processes that make up lumbar disc disease:

* Internal disc disruption

* Degenerative disc disease

* Segmental instability

Problem

Lumbar disc disease is a rather encompassing term. For example, some physicians include back pain alone as a symptom of disc disease. Others make the diagnosis without evidence of disc disease on MRI. The discussion of this article is limited to well-defined lumbar disc herniation. The pathophysiology, clinical presentation, radiographic diagnosis, treatment, and outcome are discussed.

Frequency

Although most people experience back pain during their lifetime, only a fraction experience lumbar radiculopathy or sciatica as a consequence of root compression or irritation.

Almost 5% of males and 2.5% of females experience sciatica at some time in their lifetime.

Etiology

A herniated disk fragment comes from the nucleus pulposus of the disc (a remnant of the embryonic notochord). In the normal condition, this nucleus is in the disk center securely contained by the annulus fibrosus.

When a fragment of nucleus herniates, it irritates and/or compresses the adjacent nerve root. This can cause the pain syndrome known as sciatica and, in severe cases, dysfunction of the nerve.

Presentation

Most lumbar disc herniations (lumbar disc diseases) are preceded by bouts of varying degrees and duration of back pain. In many cases, an inciting event cannot be ...