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Lumbar Disc Syndrome
Diagnosis/Definition
A condition of radicular leg pain, sometimes accompanied by low back pain which may be accompanied by a 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.
- MRI and/or CT scan are not necessary to confirm the initial diagnosis of lumbar disc syndrome except when there is failure to respond to conservative therapy or there is development of neurologic deficit (see Indications for Specialty Care Referral below).
- The initial objective of management is to reduce lumbar nerve root tension. Depending upon the severity, bed-rest or reduction of activity level for one to two weeks is indicated. Analgesics and muscle relaxants are usually helpful.
Ongoing Management and Objectives
During the acute period, the major consideration is that the sciatic pain is decreasing and overall mobility is increasing. Conservative therapy as described above is indicated.
Indications for Specialty Care Referral
A. Failure to respond to two to four weeks of conservative therapy.
- Condition A indicates a routine referral, however, a diagnostic study (MRI) should be obtained at this time by the primary care provider or at MAMC before the neurosurgery consult. Often a telephone consultation (253-968-3106) might be helpful here in establishing the need for further primary care or arranging more urgent consideration depending upon the case.
B. Worsening of sciatic pain during adequate conservative therapy.
C. Development of neurologic deficit that includes lower extremity motor or sensory deficit and/or loss of bowel or bladder control.
- Conditions B and C often indicates urgency. The patient may need to be seen immediately or possibly within 24 hours. A telephone consultation (253-968-3106) should be obtained to arrange immediate disposition. Imaging study (usually MRI) is indicated urgently.
Criteria for Return to Primary Care
Surgery is not presently indicated and a reasonable course of conservative therapy is defined which can be followed at primary care level.
Surgery has been performed, condition resolved and usual post-op follow-up is completed.
These guidelines may not be helpful in every instance. The Neurosurgery Service emphasizes telephone consultation (253-968-3106) as being an efficient and important means of improving provider communication and ultimately patient care.
