| Introduction |
 Disc degeneration is the cause of pain- Controversial but gaining acceptance as distinct cause of low back pain
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| Presentation |
- Symptoms
- axial low back pain without radicular symptoms
- pain exacerbated by
- bending
- sitting
- axial loading
- Physical exam
- nerve tension (straight leg raise) signs are negative
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| Imaging |
|
- Radiographs
- plain radiographs are the first diagnostic study to evaluate for disc degenerative
- Diskography
- Diagnosis made by provocative diskography
- must have concordant pain response
- must have abnormal disc morphology on fluoroscopy and postdiskography CT
- must have negative control levels in lumbar spine
- MRI shows degenerative discs without significant stenosis or herniation
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| Treatment |
- Nonoperative
- NSAIDS
- antispasmolytics
- Spinal bracing
- PT
- Operative
- lumbar diskectomy with fusion
- indications are controversial
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| Surgical Techniques |
- Interbody fusion +/- instrumentation
- Lumbar Disc replacement
- indications
- controversial
- most argue single level disc disease with disease-free facet joints is the only true indication
- outcomes
- showed poor results when lumbar fusion performed for discogenic pain diagnosed with a positive provacative diskography
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