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Vertebral Disc Degeneration (Acute Disc Disease (Clinical Presentation,…
Vertebral Disc Degeneration
Acute Disc Disease
Clinical Presentation
Pain is often clearly related to position and is aggravated by movement
Muscle spasm leads to a sideways tilt when standing
Sudden onset of severe back pain - often following a strenuous activity
The radiation of the pain and the clinical findings depend on the disc affected - the LOWER THREE DISCS being the MOST COMMONLY AFFECTED
Epidemiology
Disease of younger people (20-40 years) since the disc degenerates with age and in the elderly it is NO LONGER ABLE TO PROLAPSE
In older patients SCIATICA is more likely to be the result of compression (as opposed to prolapse) of the nerve root by osteophytes in the lateral recess of the spinal cord
Diagnosis
X-rays are often normal
MRI in whom surgery is being considered
Prolapse of the intervertebral disc results in acute back pain (LUMBAGO)
Treatment
Surgery only for severe or increasing neurological impairment e.g. foot drop or bladder symptoms
Physio in recovery phase - helping correct posture and restore movement
Acute stage - bed rest on a firm mattress, analgesia and epidural corticosteroid injection (severe disease)
Most commonly affected
Root lesion - L5
Pain - Buttock to lateral aspect of leg and top of foot
Reflex lost - none
Other signs - Diminished straight leg raising
Root lesion - L4
Pain - lateral aspect of thigh to medial side of calf
Reflex lost - knee jerk
Other signs - positive femoral stretch test
Root lesion - S1
Pain - buttock down back of thigh to ankle/foot
Reflex lost - ankle jerk
Other signs - Diminished straight leg raising
Chronic Disc Disease
Usually the pain is long-standing and there is no cure
NSAIDs, physiotherapy and weight reduction can be useful
Sciatic radiation may occur with pain in the buttocks radiation into the posterior thigh
Pain is usually of the mechanical type i.e. aggravated by movement
Surgery can be done when pain arises from a single identifiable level
Associated with degenerative changes in the lower lumbar discs and facet joints