Epidemiology
1. Ages affected
  1. Most common ages 30 to 50 years
  2. Rarely occurs before age 20 years
2. Most common spinal levels affected (95% of lumbar disc)
  1. Vertebral level L4-5
  2. Vertebral level L5-S1
Mechanism
1. Progressive degeneration of disc nucleus pulposus
  1. Results from normal aging or repetitive trauma
2. Protrusion of disc (most commonly posterior-lateral)
  1. Herniation affects spinal root one level below
3. Other Changes: Spondylosis (Chronic disc deterioration)
  1. Spur Formation
  2. Disc space narrowing
  3. Facet joint degeneration
Complications
1. Cauda Equina Syndrome
Symptoms
1. Usually insidious onset
  1. Acute trauma may have preceded symptoms
2. Low Back Pain (deep aching)
  1. Aggravated by activity, coughing, and sneezing
  2. Relieved by rest
  3. Localized to affected disc
3. Intense Radicular Pain
  1. Referred pain to iliac crest or buttock
  2. Radiation of pain down posterior thigh and calf
  3. Pain may radiate into foot
4. Paresthesias
  1. Numbness or tingling in distal extremity
Signs
1. Restricted low back range of motion
2. Pain exacerbated by bending to affected side
3. Local tenderness and muscle guarding
4. Posturing to avoid pressure on disc
  1. Bent away from affected side
  2. Hip and knee flexed on affected side
5. Nerve Root Tension Tests
  1. Straight Leg Raise
6. Neurologic Examination
Differential diagnosis
1. Musculoskeletal Low Back Pain
2. Spinal Cord Tumor
  1. Consider especially in age under 20 or over 60 years
  2. Relentless pain aggravated or not relieved with rest
Management: Rehabilitation
1. See Lumbar Disc Disease Management
2. See Low Back Rehabilitation
3. See Low Back Muscle Fusion Rehabilitation
Course
1. Spontaneous recovery is the rule (90% in 6 weeks)
2. Long-term outcomes are not improved with surgery
References

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This page was written by Scott Moses, MD. This page was last revised before 5/10/08, prior to consistent tracking of revision date. This page was last published on 6/1/2008. Please send comments and questions to the editor. Contact information may be found on the page About the Family Practice Notebook. These pages are best viewed with Microsoft Internet Explorer 6.0.