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Lumbar Disk Disorders
OVERVIEW: Many patients with low back pain have lumbar disc disease and involvement of surrounding spinal ligaments, muscles, and bones. Over time, disc degeneration, herniation, and arthritic
changes may develop.
SIGNS AND SYMPTOMS: • Variable pain; usually dull, originating in back, extending below knee
• Back pain decreases at night. Bed rest usually improves symptoms at least temporarily.
• Pain increases with sitting or standing.
• Sciatica can occur without back pain.
• Tingling, numbness, loss of sensation in legs and feet
• Muscle weakness
• Muscle spasm
CAUSES: • Injury
• Frequent lifting of heavy objects, especially if improper technique is used
• Vibration; e.g., driving motor vehicles
SCOPE: • 60-90% of Americans experience lumbar back disorder in their lifetime. It is one of the most common reasons for seeking medical attention.
MOST OFTEN AFFECTED: Individuals 25-45 years of age, with the first episode in 20s and 30s; infrequent before 20
years of age or after age 65. Males and females are affected with equal frequency.
RISK FACTORS: • Normal aging process after age 20
• Cigarette smoking
• Spine disorders
• Stress, muscle tension
• Obesity
DIAGNOSIS PHYSICAL EXAMINATION: • The Physician will perform a complete physical examination to evaluate back function.
• Numerous other disorders can cause similar symptoms, including strains, arthritis, fracture, poor posture, bursitis, cancers, infection, and other conditions.
TESTS AND PROCEDURES: • Blood tests
• X-rays of affected area of back
• Other special radiology procedures that may be done include myelography, computed tomography (CT scan), magnetic resonance imaging (MRI), and bone scan.
TREATMENT GENERAL MEASURES: • Most cases of lumbar disk disorders are managed in the outpatient setting.
• Severe disability or surgery may require hospitalization.
• Initial: minimal bedrest, ordinary activities as tolerated, local heat, pelvic traction, sedation, physical therapy
• For chronic pain: Improve physical fitness with low impact aerobic exercise. Manipulation and physical therapy have shown to be beneficial.
• Transcutaneous electrical nerve stimulation (TENS): very short-term benefit
• Surgery may be required.
ACTIVITY: • After pain is controlled (2-4 days), begin progressive walking program. Short walks initially 4 times a day and lengthen as tolerated.
• Return to work as soon as possible but avoid high-risk activities, e.g., heavy lifting, vibration, smoking.
DIET: Weight reduction if appropriate
MEDICATIONS COMMONLY PRESCRIBED DRUGS: • Pain relievers
• Nonsteroidal anti-inflammatory medication (NSAIDs)
• Mild sedatives
CONTRAINDICATIONS: Read drug product information.
PRECAUTIONS: Elderly, hypertension, peptic ulcer disease or bleeding, kidney disease, liver disease, cardiac
dysfunction
DRUG INTERACTIONS: Read drug product information.
Other Drugs: N/A
FOLLOW UP PATIENT MONITORING: • The Physician should be seen about 10 days following initial visit.
• Thereafter, the doctor should be seen every 2 weeks until full function returns.
PREVENTION/AVOIDANCE: • Modification of jobs to reduce exposure to known risk factors.
• Selection of workers by strength testing for certain jobs
• Avoid smoking
• Use proper lifting technique.
• Use good posture.
• Weight control
COMPLICATIONS: • Pain relievers
• Nonsteroidal anti-inflammatory medication (NSAIDs)
• Mild sedatives
WHAT TO EXPECT: • Expect to recover spontaneously with conservative therapy.
• Chronic pain: Most patients respond to conservative management such as manipulation, fitness, weight reduction, and good back care habits. Surgery produces good results in selected cases.
MISCELLANEOUS OTHER FACTORS: N/A
PEDIATRIC: N/A
GERIATRIC: N/A
OTHERS: N/A
PREGNANCY: Pregnancy is commonly associated with low back pain and/or sciatica. Treatment is conservative.
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