summary Discogenic Back pain is a common cause of axial low back pain without radicular symptoms caused by intervertebral disc degeneration. Diagnosis is made by a combination of history, physical examination, and MRI studies. Treatment is usually NSAIDS, physical therapy, cognitive therapy and lifestyle modifications. Etiology Mechanism disc characteristics modified by bone morphogenic proteins 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 Imaging Radiographs plain radiographs are the first diagnostic study to evaluate for disc degeneration MRI shows degenerative discs without significant stenosis or herniation Provocative Diskography criteria for a positive test must have concordant pain response must have abnormal disc morphology on fluoroscopy and postdiskography CT must have negative control levels in lumbar spine outcomes studies have show provocative diskography leads to accelerated disc degeneration including increased incidence of lumbar disc herniations loss of disk height endplate changes Treatment Nonoperative NSAIDS, physical therapy, cognitive therapy, lifestyle modifications indications treatment of choice of majority of patients with low back pain in the abscence of leg pain outcomes no statisically significant difference in ODI at short (1 year) or long term (10 years) for patients treated with cognitive and exercise therapy compared to lumbar diskectomy with fusion Operative lumbar diskectomy with fusion indications controversial outcomes poor results when lumbar fusion is performed for discogenic back pain diagnosed with a positive provocative discography lumbar total disc replacement indications controversial most argue single level disc disease with disease-free facet joints is the only true indication outcomes shown to have better 2-year patient outcomes than fusion lower rates of adjacent segment disease with total disc replacement compared to fusion complications persistent back pain thought to be facet joint in origin or subtle instability of prosthesis if implant in good position, treat with posterior stabilization alone dislocation of polyethylene inlay treat with either revision arthroplasty or revision to arthrodesis
QUESTIONS 1 of 7 1 2 3 4 5 6 7 Previous Next Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (OBQ12.170) Which of the following procedures has been found to lead to accelerated disc degeneration and the development of reactive endplate changes? QID: 4530 Type & Select Correct Answer 1 Provocative discography 86% (4111/4769) 2 Lumbar myelogram 2% (76/4769) 3 Cervical myelogram 1% (27/4769) 4 Lumbar transforaminal epidural steroid injections 10% (494/4769) 5 Lumbar spinal anesthesia 1% (32/4769) L 1 Question Complexity B Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 1 Review Tested Concept Review Full Topic (SBQ09SP.1) A 45-year-old construction worker presents to your office with a chief complaint of 3 weeks of low back pain. He states the pain started while he was at work and he now has a difficult time working a full day. He reports the pain is worse with activity but he cannot describe any certain positions that make it worse. He denies any recent history of fever, night sweats, or weight loss. He reports normal bowel and bladder function and denies symptoms radiating into his buttocks or legs. On physical exam he has 5/5 strength in his lower extremities, a normal sensory and reflex exam. Forward flexion of the lumbar spine elicits pain in his lower back. He is able to touch his knees when bending forward, but is unable to touch his toes secondary to pain. What is the most appropriate next step in management? QID: 3364 Type & Select Correct Answer 1 Lumbar spine x-rays 21% (397/1878) 2 Lumbar spine MRI 2% (36/1878) 3 Lumbar discography 0% (5/1878) 4 Oral methylprednisoline taper 0% (4/1878) 5 Physical therapy and NSAIDs 76% (1421/1878) L 4 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 5 Review Tested Concept Review Full Topic Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK
All Videos (0) Podcasts (1) Spine⎪Discogenic Back Pain Orthobullets Team Spine - Discogenic Back Pain Listen Now 17:24 min 1/14/2020 226 plays 4.6 (5)