Lumbar Disc Syndrome

Diagnosis/Definition

• A condition of radicular leg pain, sometimes accompanied by low back pain and may be accompanied by motor or sensory deficit.

Initial Diagnosis and management

• The initial diagnosis is clinical with the acute or subacute development of low back pain usually with sciatic pain following minimal low back trauma in patients under the age of 50.  No x-ray or lab studies are necessary.
• Over the age of 50, disc abnormalities are possible, but initial lumbar sacral spine series should be considered which might exclude bony structural abnormalities such as severe degenerative changes, osteoporosis with compression or metastatic involvement. 
• “Red Flags” include fever, chills, unintended weight loss, history of cancer, immunodeficiency, worsening of neurologic deficits (lower extremity weakness, drop foot, loss of reflexes, and bowel/bladder incontinence) , or physical evidence of deformity.
• MRI and/or CT scan are not necessary to confirm the initial diagnosis of lumbar disc syndrome except when there is failure to respond after 4 to 6 weeks of conservative therapy; there are “red flags” present; or there is worsening of neurologic deficits (see Indications for Specialty Care Referral below).
• Conservative therapy is a defined as limited bed-rest (less than 72 hours), reduction of overall activity level for 2 weeks with a trial of nonsteroidal anti-inflammatory medications, steroid taper for radiculopathy, narcotic analgesia as necessary and muscle relaxants. Referral to Physical Therapy can be made to supplement treatment during 2 to 4 weeks of conservative therapy.

Ongoing Management and Objective

• During the acute period, the major consideration is that the low back pain and radicular pain are decreasing and overall mobility is increasing. Conservative therapy as described above is indicated.

Indication a profile is needed

• Any limitations that affect strength, range of motion, and general efficiency of the back.
• Slightly limited mobility of joints, muscular weakness, or other musculo-skeletal defects that may prevent hand-to-hand fighting and disqualifies for prolonged effort.
• Defects or impairments that require significant restriction of use