Presentation
The classical presentation of CES is not obvious. Even if surgery is performed late due to delayed presentation, significant improvement in neurologic and bladder function can still be expected. Copyright 2014, SLACK Incorporated. [ncbi.nlm.nih.gov]
A 29-year-old woman presented to the spine clinic with new-onset pain in her right leg, accompanied by paresthesia. There were no bowel or bladder symptoms. [nejm.org]
Entire Body System
- Limb Pain
Review Topic QID: 3706 1 Equal limb pain and equal functional outcomes 2 Improved limb pain and improved functional outcomes 3 Worsened limb pain and worsened functional outcomes 4 Worsened limb pain but improved functional outcomes 5 Improved limb pain [orthobullets.com]
- Lower Extremity Pain
Review Ohnmeiss DD, Vanharanta H, Ekholm J:Degree of disc disruption and lower extremity pain. Spine. 1997 Jul 15;2214:1600-5. 8.Spencer DL: The anatomical basis of sciatica secondary to herniated lumbar disc: a review. [hss.edu]
He has 5/5 strength in the all other muscle groups in his lower extremities and symmetric 1+ patellar and Achilles reflexes bilaterally. [orthobullets.com]
- Soft Tissue Mass
mass within or lateral to the intervertebral foramen. [ncbi.nlm.nih.gov]
Gastrointestinal
- Constipation
Very large disc herniations may result in urinary difficulty and constipation. In cervical disc herniation, the spinal cord as well as the nerve roots may be compressed. [uclahealth.org]
Constipation is a common side-effect from codeine. This may make back pain worse if you need to strain to go to the toilet. To prevent constipation, have lots to drink and eat foods with plenty of fibre. [patient.info]
Side effects include sedation, nausea, and constipation. Epidural steroid medication (injected into the space just outside of the sac of spinal fluid), reduces swelling, inflammation, and pain. [innerbody.com]
- Fecal Incontinence
If the anal sphincter is not working, fecal incontinence may occur. This means the patient loses the ability to control the passage of stool from the bowels. If the urethral sphincter is not working properly, urine leaks from the bladder. [livestrong.com]
incontinence as well as sexual dysfunction. [physio-pedia.com]
Musculoskeletal
- Back Pain
The patient initially suffered from unilateral low back pain and nonradicular/nonlancinating referral to the ipsilateral lower extremity. [ncbi.nlm.nih.gov]
“Red flags” for potentially serious underlying causes of low back pain. Adapted from ACR Appropriateness Criteria: Low Back Pain. 3 Figure 3. “Red flags” for potentially serious underlying causes of low back pain. [jaoa.org]
Home > Causes of Back Pain > Lower Back Pain > Lumbar Disk Herniation Free Back Surgery Guide! [greatriverspineclinic.com]
- Low Back Pain
The patient initially suffered from unilateral low back pain and nonradicular/nonlancinating referral to the ipsilateral lower extremity. [ncbi.nlm.nih.gov]
“Red flags” for potentially serious underlying causes of low back pain. Adapted from ACR Appropriateness Criteria: Low Back Pain. 3 Figure 3. “Red flags” for potentially serious underlying causes of low back pain. [jaoa.org]
- Spine Pain
Thoracic disc herniation presents most commonly as chest pain or spine pain, and occasionally in numbness, weakness, or spasticity. [uclahealth.org]
Low back pain and/or leg pain (sciatica) are the most common symptoms of a herniated disc in the lumbar (lower) spine. Pain may vary from mild to severe. [treatingpain.com]
[…] the waist down Bulging disc in your cervical spine: Pain moving your neck Deep pain near or over your shoulder blade Radiating pain in your upper arm, forearm, and possibly your fingers Pain from a bulging disc may start slowly and get worse over time [depuysynthes.com]
It can help lessen the pain by strengthening the muscles that support your spine. [patient.info]
- Acute Low Back Pain
Familial predisposition to discogenic low-back pain. An epidemiologic and immunogenetic study. Spine. 1988;13:1403–6. 6. Bigos SJ. Acute low back problems in adults. Rockville, Md.: U.S. [aafp.org]
DC, PT: Comparison of Classification-Based Physical Therapy With Therapy Based on Clinical Practice Guidelines for Patients with Acute Low Back Pain: A Randomized Clinical Trial. Spine. 2813:1363-1371, July 1, 2003. [hss.edu]
Spinal Manipulative Therapy and Mobilization - Spinal manipulative therapy and mobilization leads to short-term pain relief when suffering from acute low back pain. [physio-pedia.com]
- Paravertebral Muscle Spasm
On physical examination a compensatory gait, paravertebral muscle spasm, and a restricted right straight-leg raising test were demonstrated. Plain x-ray films revealed a narrowed L4–5 intervertebral space. [thejns.org]
Weight Loss Weight loss is observed during initial phase because of loss of appetite secondary to chronic pain Clinical Signs- Lumbar Disc Bulge Paravertebral Muscle Spasm Muscle Spasm- Muscle spasm is often reflex spasm of paravertebral muscles secondary [epainassist.com]
Neurologic
- Sciatica
Secondary outcomes included sciatica severity as measured by the Sciatica Bothersomeness Index, satisfaction with symptoms, self-reported improvement, and employment status. [ncbi.nlm.nih.gov]
Sciatica is a common diagnosis in the general population. Sciatica is most frequently caused by LDH. [sogacot.org]
Sciatica due to a herniated lumbar intervertebral disk is common and has an estimated point prevalence of roughly 5% in the general adult population. 1 Numerous prospective studies have reported excellent recovery of acute sciatica in the absence of significant [cmaj.ca]
- Paresthesia
A 29-year-old woman presented to the spine clinic with new-onset pain in her right leg, accompanied by paresthesia. There were no bowel or bladder symptoms. [nejm.org]
CLINICAL FEATURES: A 31-year-old man presented with severe lower back pain and pain, paresthesia, and plantar flexion weakness of the left leg. [ncbi.nlm.nih.gov]
His history was significant only for a spontaneous onset of lumbar back pain noted immediately after awkward bending six months prior, followed two to three days later by severe leg pain, paresthesias and ankle weakness, consistent with an L5 radiculopathy [cmaj.ca]
- Foot Drop
Foot drop is defined as inability to dorsiflex the foot at the ankle joint. [ncbi.nlm.nih.gov]
Neurological symptoms caused by the herniation may include difficulty lifting the foot when walking or standing on the ball of the foot, a condition known as foot drop. See What Is Foot Drop? Article continues below Lower back pain. [spine-health.com]
In those with severe extensor weakness, especially painless foot-drop, diskectomy does not improve the outcome.” Discrimination between foot drop and severe extensor weakness may not be possible or reasonable. [healio.com]
Weakness in the foot is especially common, with difficulty lifting the foot (known as foot drop) often reported in those with L4/L5 herniation. [sportsinjuryclinic.net]
- Limb Weakness
Additions symptoms of lumbar spondylosis include: Localized pain Pain after prolonged sitting Worsening pain after repeated movement Muscle spasms Regional tenderness Tingling, numbness in the limbs Weakness of affected limb due to possible nerve compression [bodhiwellnesscentre.com]
We report a 45-year-old male who presented with sudden onset right lower limb weakness after lifting heavy weight. Magnetic resonance imaging of the cervical spine showed C5/6 disc prolapse with intradural extension. [read.qxmd.com]
- Neuralgia
[…] non-draft ICD-10-CM) 2017 (effective 10/1/2016) : No change 2018 (effective 10/1/2017) : No change 2019 (effective 10/1/2018) : No change Disorder (of) - see also Disease disc (intervertebral) M51.9 Neuritis (rheumatoid) M79.2 ICD-10-CM Diagnosis Code M79.2 Neuralgia [icd10data.com]
Community Wiki Code: M54.16 Code Name: ICD-10 Code for Radiculopathy, lumbar region Block: Other dorsopathies (M50-M54) Excludes 1: current injury - see injury of spine by body region discitis NOS (M46.4-) Details: Radiculopathy, lumbar region Excludes1: neuralgia [aapc.com]
Workup
[…] invasive Plain lumbar films: Generally not helpful in the diagnosis, except to rule out other diseases and to evaluate for possible skeletal etiology as the cause of the patient's symptoms Bone scanning: To rule out tumors, trauma, or infection See Workup [emedicine.medscape.com]
Treatment
In group A, treatment was a success (excellent or good outcome) in 70.3% and deemed a failure (poor outcome or recourse to surgery) in the remaining 29.7%. In group B, treatment was a success in 78.3% and deemed a failure in the remaining 21.7%. [ncbi.nlm.nih.gov]
Prognosis
In patients with chronic or recurrent disk herniation, the prognosis for recovery from pain or dysfunction is often poor. [ncbi.nlm.nih.gov]
Please suggest me the best possible treatement and the prognosis. [practo.com]
[…] symptoms of: Back pain that spreads down the front of the leg into the knee You may have weakness when flexing at the hip or extending the knee Feeling may be decreased or reduced over the front of the thigh and the inside part of the calf Treatment and Prognosis [pagelaw.com]
used to diagnose L5 and S1 radiculopathy; - femoral stretch test: used to diagnose L4 radiculopathy; - this test is performed by raising the leg while the patient is prone; - wt relief flexion test: - MRI of Disc Herniation : - Natural History: - prognosis [wheelessonline.com]
Etiology
Abstract The authors have retrospectively studied the trends in etiology, symptoms, and rate of recurrence for adolescents with disk herniations to determine the age at onset of symptoms, mechanism of injury, familial history, pattern of symptoms, level [ncbi.nlm.nih.gov]
Discal etiology can be suggested by clinical observation in patients complaining of classical lower back pain, but not excluded even without musculoskeletal pain. [read.qxmd.com]
[…] scanning: Useful but less sensitive than MRI Myelography: May provide definitive diagnosis itself, but technique is invasive Plain lumbar films: Generally not helpful in the diagnosis, except to rule out other diseases and to evaluate for possible skeletal etiology [emedicine.medscape.com]
Potential Etiologies Lumbar disc herniations can occur as a result of direct trauma or gradual degeneration over time. [morphopedics.wikidot.com]
Epidemiology
It is important for both patients and spine surgeons to understand epidemiology trends and outcomes of revision surgery for real recurrent lumbar disk herniation (real-RLDH). [ncbi.nlm.nih.gov]
Epidemiology of spinal disorders. In: Frymoyer JW, Ducker TB, Hadler NM, et al., eds. The adult spine: principles and practice. New York: Raven Press, 1997:93–141. 5. Heliovaara M. Epidemiology of sciatica and herniated lumbar intervertebral disk. [aafp.org]
An epidemiological study of the relationship between occupations and acute herniated lumbar intervertebral discs. Int J Epidemiol 1975;4:197-205. [ PUBMED ] 37. Stairmand JW, Holm S, Urban JP. [dx.doi.org]
Lumbar disc degeneration: epidemiology and genetics. J Bone Joint Surg AM. 2006;88(2):3-9. Institute for Quality and Efficiency in Health Care (IQWiG). Slipped disk: overview. 2014; n.pag. [paindoctor.com]
Epidemiology The lifetime prevalence of low back pain is 80%, with disk disorders being the most common cause of adult low back pain. [emedicine.medscape.com]
Pathophysiology
Abstract To better understand the pathophysiologic mechanisms underlying spinal nerve root injury induced by lumbar disk herniation (LDH), comparative proteomic analysis of cerebrospinal fluid (CSF) between patients with LDH (the experiment group) and [ncbi.nlm.nih.gov]
Pathophysiology The disc consists of the annulus fibrosus (a complex series of fibrous rings) and the nucleus pulposus (a gelatinous core containing collagen fibers, elastin fibers and a hydrated gel)[10]. [physio-pedia.com]
To obtain more insight into the pathophysiology of the disease, several association and candidate gene analyses have been performed. [asbmr.onlinelibrary.wiley.com]
Prevention
It is essential to pay careful attention to prevent a dural tear. Patients may expect clinical outcomes similar to those following primary discectomy. [ncbi.nlm.nih.gov]
Prevention Tips for preventing a herniated disk include: avoiding obesity or losing weight, if necessary learning the correct techniques for lifting and handling resting and seeking help if symptoms occur Although it can sometimes be extremely painful [medicalnewstoday.com]
Can lumbar disk disease be prevented? Maintaining a healthy weight, participating in regular exercise, and using good posture can lessen your risk for lumbar disk disease. [hopkinsmedicine.org]