Lumbar disc disease

Lumbar disc disease is a very common entity with a high asymptomatic prevalence. Intervertebral disc abnormalities are found in 25% of individuals below the age of 60, and over 50% in those over the age of 60. It is therefore not enough to demonstrate a disc lesion in someone with non specific back pain, as the conspicuous lesion may not be the cause of the pain. Careful correlation with clinical presentation (e.g. myotomal weakness, dermatomal numbness) as well as with spinal interventional procedures (e.g. spinal epidural injection, facet joint injection, transforaminal injection) is necessary to confirm that a particular disc lesion is indeed causative.

It has been well documented that a large proportion of even large disc lesions spontaneously resolve (1/3 resolve within 6 weeks, another 1/3 (i.e. 2/3 of all large disc lesions) within 6 months).

Description of disc disease can be often confusing. It is worth separating the appearance and the location of disc disease, as this has implications as to both likely nerve root entrapment, as well as surgical approach. The terms bulge, protrusion, extrusion, sequestration and migration all have specific meanings although the definitions vary from publication to publication. For a discussion of these terms please refer to intervertebral disc disease nomenclature.

The aetiology of disc disease is more than simple wear-and-tear, with genetics playing a significant role, likely to be the dominant factor over and above environmental factors.