Lumbar disc disease

Last revised by Frank Gaillard on 16 May 2016

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 and dermatomal numbness), as well as, with interventional spinal 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 six weeks, another 1/3 (i.e. 2/3 of all large disc lesions) within six months).

Description of disc disease can often be confusing. It is worth separating the appearance and the location of disc disease, as this has implications as to both possible 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 etiology 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.

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