Condition: Lumbar disk disorders include degenerative disk disease, disk herniations, and infectious causes. These disorders are caused by problems with the cushioning between the vertebrae in the lower back.
Background: The lifetime prevalence of low back pain is 80%, and disk disorders are the most common cause of adult low back pain. Fortunately, approximately 90% of patients with low back pain have improvement within 6 weeks without medical intervention.
Risk Factors: Increasing age is the most important risk factor for degeneration. Other risk factors include higher body mass index, genetics, and smoking.
History and Symptoms: Pain, which is often described as aching, sore, or stabbing, in the middle lower back is most common, although pain can also occur in the groin, genitals, buttocks, and limbs. The onset of the pain may or may not occur following a specific event. Pain worsens with sitting, twisting, lifting, coughing, or sneezing and improves with position changes or standing. Medical history of spine surgeries, cancer, drug use, infections, and psychiatric conditions is important for diagnosis.
Physical Exam: A physical exam will be performed to examine preferred positioning, body weight, range of motion, and vital signs that may indicate other causes. The painful region will be examined, and sensation, strength, reflexes, and walking ability will be evaluated. Bowel or bladder issues, numbness, or weakness indicate that more serious conditions may be at play.
Diagnostic Process: Blood tests can be used to determine whether whole-body infections, inflammatory diseases, or arthritis are involved. X-rays, MRI, CT, and bone scans are often used as imaging techniques to diagnose lumbar disk disorders. Since lumbar disc disorders are so common, each of these tests should be correlated with your history and physical examination. Physical medicine and rehabilitation (PM&R) physicians are uniquely positioned to diagnose lumbar disc disorders by using a comprehensive physical examination to ensure the diagnostic test results are relevant to the patient’s symptoms.
Rehab Management: Conservative treatment involves non-steroidal anti-inflammatory drugs (NSAIDS), relative rest, and then rehabilitation exercises. PM&R physicians can provide a precise physical therapy prescription to correct any biomechanical deficits and provide long lasting relief. If additional treatment is necessary, epidural steroid injections can be used to provide pain relief and functional improvement. Surgery including disk fusion is also an option, especially if complications (neurological problems or cauda equina syndrome) occur. In the face of chronic pain, the presence of depression or other diseases should be addressed, and exercise should be encouraged.
Other Resources for Patients and Families: Patients and families should receive education about injury prevention, proper posture, proper lifting techniques, and the role of exercise in treatment.