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discogenic back pain physical exam

W Michael Hooten, Steven P Cohen
Low back pain (LBP) is a leading cause of disability worldwide. In the absence of a classification system for pain syndromes, classification of LBP on the basis of the distribution of pain as axial (pain generally localized to the low back) or radicular neuropathic (pain radiating to the lower extremities) is relevant to clinical practice because the distribution of pain is often a corollary of frequently occurring disease processes involving the lumbar spine. Common sources of axial LBP include the intervertebral disc, facet joint, sacroiliac joint, and paraspinal musculature, whereas common sources of radicular pain include a herniated intervertebral disc and spinal stenosis...
December 2015: Mayo Clinic Proceedings
Do-Keun Kim, Chang Hyun Oh, Myoung Seok Lee, Seung Hwan Yoon, Hyung-Chun Park, Chong Oon Park
OBJECTIVE: The authors surveyed the prevalence and the clinical character of lumbar disc herniation (LDH) in Korean male adolescents, and the usefulness of current conscription criteria. METHODS: The data of 39,673 nineteen-year-old males that underwent a conscription examination at the Seoul Regional Korean Military Manpower Administration (MMA) from October 2010 to May 2011 were investigated. For those diagnosed as having lumbar disc herniation, prevalences, subject characteristics, herniation severities, levels of herniation, and modified Korean Oswestry low back pain disability scores by MMA physical grade were evaluated...
December 2011: Korean Journal of Spine
Ryan S Reeves, Michael B Furman
SUMMARY Lumbar provocation discography is a commonly used diagnostic procedure utilized to determine the presence or absence of discogenic pain at a specific spinal segment. Although multidisciplinary societies have recognized discography as the primary criterion for identifying discogenic pain, the test remains controversial. Skeptics argue against its sensitivity and specificity, and suggest that it's risks outweigh any potential benefits. However, when properly performed and interpreted, discography is an invaluable tool...
March 2012: Pain Management
Adem Parlak, Aykut Aytekin, Sedat Develi, Safak Ekinci
Piriformis syndrome is a clinical picture of non-discogenic sciatica caused by compression of the sciatic nerve by the piriformis muscle. It has variable etiologies and the patho-physiology is not fully understood. The major etiology was known to be the spasm, edema and inflammation of the piriformis muscle and sciatic nerve compression of the muscle later on. Patients can be diagnosed immediately with a comprehensive clinical examination and early diagnosis makes the treatment much easier. Diagnosis of the piriformis syndrome, a very rare cause of low back pain, first requires that this syndrome is remembered, and then a differential diagnosis should be performed...
2014: Turkish Neurosurgery
Steven P Cohen, Yian Chen, Nathan J Neufeld
Sacroiliac joint (SIJ) pain is an underappreciated source of mechanical low back pain, affecting between 15 and 30% of individuals with chronic, nonradicular pain. Predisposing factors for SIJ pain include true and apparent leg length discrepancy, older age, inflammatory arthritis, previous spine surgery, pregnancy and trauma. Compared with facet-mediated and discogenic low back pain, individuals with SIJ pain are more likely to report a specific inciting event, and experience unilateral pain below L5. Owing in part to its size and heterogeneity, the pain referral patterns of the SIJ are extremely variable...
January 2013: Expert Review of Neurotherapeutics
Yang Yu, Wei Liu, Dianwen Song, Qunfeng Guo, Lianshun Jia
OBJECTIVE: The purpose of the current study was to determine, whenever the patients complained of probable symptoms of discogenic low back pain and had obvious disc pathological changes on magnetic resonance imaging (MRI) but showed negative in discography, whether we could absolutely exclude the diagnosis of discogenic pain or not. METHODS: The patients we selected in our study had only one segmental disc pathology on MRI for the purpose of minimizing the interference and all patients complained of probable discogenic pain symptoms...
May 2012: Archives of Orthopaedic and Trauma Surgery
Vanessa G Cuellar, Jason M Cuellar, Alexander R Vaccaro, Eugene J Carragee, Gaetano J Scuderi
STUDY DESIGN: Observational cohort study. SUMMARY OF BACKGROUND DATA: Studies evaluating the treatment of presumed discogenic spine pain using nucleoplasty have reported variable success rates. It has been suggested that these procedures lower the intradiscal pressure, reduce disk protrusion, improve disk hydration, and restore disk height. It is proposed that such structural changes in treated disks correspond to the clinical improvement in patients. Radiographic and clinical evidence showing the efficacy of nucleoplasty remains inadequate...
December 2010: Journal of Spinal Disorders & Techniques
Seiji Ohtori, Shinichiro Nakamura, Takana Koshi, Masaomi Yamashita, Kazuyo Yamauchi, Gen Inoue, Sumihisa Orita, Yawara Eguchi, Munetaka Suzuki, Nobuyasu Ochiai, Shunji Kishida, Masashi Takaso, Yasuchika Aoki, Kazuki Kuniyoshi, Junichi Nakamura, Tetsuhiro Ishikawa, Gen Arai, Masayuki Miyagi, Hiroto Kamoda, Miyako Suzuki, Yuzuru Takahashi, Tomoaki Toyone, Masatsune Yamagata, Kazuhisa Takahashi
BACKGROUND: It has been reported that rat L5/6 lumbar discs are innervated mainly by L2 dorsal root ganglion neurons. We previously reported that L2 spinal nerve infiltration was effective for discogenic low back pain (DLBP) patients, although the diagnosis was based only on the results of physical examination, plain films, and magnetic resonance imaging (MRI). The purpose of the current study was to evaluate L2 spinal nerve block for DLBP patients retrospectively based on MRI findings and surgical results...
November 2010: Journal of Orthopaedic Science: Official Journal of the Japanese Orthopaedic Association
Hsi-Kai Tsou, Shao-Ching Chao, Ting-Hsien Kao, Jia-Jean Yiin, Horng-Chaung Hsu, Chiung-Chyi Shen, Hsien-Te Chen
BACKGROUND: Low back pain (LBP) has become a main cause of absenteeism and disability in industrialized societies. Chronic LBP is an important health issue in modern countries. Discogenic LBP is one of the causes of chronic low back pain. The management of chronic discogenic LBP has been limited to either conservative treatment or operative treatment. Intradiscal electrothermal therapy (IDET) is now being performed as an alternative treatment. METHODS: Ninety-three consecutive patients undergoing IDET at 134 disc levels from October 2004 to January 2007 were prospectively evaluated...
2010: Surgical Neurology International
Taryn E Hill, Geoffrey T Desmoulin, Christopher J Hunter
Epidemiological data at one time was taken to suggest that chronic vibrations--for example operating vehicles with low-quality seats--contributed to intervertebral disc degeneration and lower back pain. More recent discussions, based in part upon extended twin studies, have cast doubt upon this interpretation, and question how much of the vibration is actually transmitted to the spine during loading. This review summarizes our recent survey of the current state of knowledge. In particular, we note that current studies are lacking a detailed factorial exploration of frequency, amplitude, and duration; this may be the primary cause for inconclusive and/or contradictory studies...
December 11, 2009: Journal of Biomechanics
Laxmaiah Manchikanti, Standiford Helm, Vijay Singh, Ramsin M Benyamin, Sukdeb Datta, Salim M Hayek, Bert Fellows, Mark V Boswell
Interventional pain management, and the interventional techniques which are an integral part of that specialty, are subject to widely varying definitions and practices. How interventional techniques are applied by various specialties is highly variable, even for the most common procedures and conditions. At the same time, many payors, publications, and guidelines are showing increasing interest in the performance and costs of interventional techniques. There is a lack of consensus among interventional pain management specialists with regards to how to diagnose and manage spinal pain and the type and frequency of spinal interventional techniques which should be utilized to treat spinal pain...
July 2009: Pain Physician
Luke Madigan, Alexander R Vaccaro, Leo R Spector, R Alden Milam
Symptomatic lumbar degenerative disk disease, or discogenic back pain, is difficult to treat. Patients often report transverse low back pain that radiates into the sacroiliac joints. Radicular or claudicatory symptoms are generally absent unless there is concomitant nerve compression. Physical examination findings are often unremarkable. Radiographic examination may reveal disk space narrowing, end-plate sclerosis, or vacuum phenomenon in the disk; magnetic resonance imaging is useful for revealing hydration of the disk, annular bulging, or lumbar spine end-plate (Modic) changes in the adjacent vertebral bodies...
February 2009: Journal of the American Academy of Orthopaedic Surgeons
Ajay Jawahar, Stephen M Brandao, Christopher Howard, Pierce D Nunley
OBJECTIVE: This prospective study was conducted to evaluate improvements in pain and disability in a series of 53 consecutive worker's compensation patients with discogenic low back pain following treatment with the intradiscal electrothermal therapy (IDET) procedure. MATERIAL AND METHODS: Between 2002 and 2004, a total of 53 consecutive patients, who were claimants of worker's compensation, were treated using IDET for their discogenic low back pain. The outcomes of these patients were analyzed statistically for the current study by physical exam and self-assessment questionnaires of pain and disability at baseline and at 24-months post-procedure...
September 2008: Journal of the Louisiana State Medical Society: Official Organ of the Louisiana State Medical Society
Duygu Geler Kulcu, Sait Naderi
The aim of this study is to present a series of 11 patients with non-discogenic sciatica (NDS), and to review the diagnostic techniques of careful clinical and radiological examination. The cases include lumbar radicular herpes zoster, lumbar nerve root schwannoma, lumbar instability, facet hypertrophy, ankylosing spondylitis, sacroiliitis, sciatic neuritis, piriformis syndrome, intrapelvic mass and coxarthrosis. The pain pattern and accompanying symptoms were the major factors suggesting a non-discogenic etiology...
November 2008: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
Pierce D Nunley, Ajay Jawahar, Stephen M Brandao, Kimberly M Wilkinson
OBJECTIVE: This prospective study was conducted to evaluate improvements in pain and disability in a series of 53 consecutive worker's compensation patients with low back pain (LBP) after treatment with the intradiscal electrothermal therapy (IDET) procedure. MATERIALS AND METHODS: All patients seen in the out-patient clinic of the Spine Institute of Louisiana for LBP of discogenic origin were screened for eligibility to receive IDET procedure. A total of 134 patients were treated using IDET for their discogenic LBP during the study period...
February 2008: Journal of Spinal Disorders & Techniques
Jack Zigler, Rick Delamarter, Jeffrey M Spivak, Raymond J Linovitz, Guy O Danielson, Thomas T Haider, Frank Cammisa, Jim Zuchermann, Richard Balderston, Scott Kitchel, Kevin Foley, Robert Watkins, David Bradford, James Yue, Hansen Yuan, Harry Herkowitz, Doug Geiger, John Bendo, Timothy Peppers, Barton Sachs, Federico Girardi, Michael Kropf, Jeff Goldstein
STUDY DESIGN: A prospective, randomized, multicenter, Food and Drug Administration-regulated Investigational Device Exemption clinical trial. OBJECTIVE: To evaluate the safety and effectiveness of the ProDisc-L (Synthes Spine, West Chester, PA) lumbar total disc replacement compared to circumferential spinal fusion for the treatment of discogenic pain at 1 vertebral level between L3 and S1. SUMMARY OF BACKGROUND DATA: As part of the Investigational Device Exemption clinical trial, favorable single center results of lumbar total disc replacement with the ProDisc-L have been reported previously...
May 15, 2007: Spine
Alexander Yakovlev, Mazin Al Tamimi, Hong Liang, Maria Eristavi
BACKGROUND: Percutaneous disc decompression utilizing Nucleoplasty has emerged as one of the minimally invasive techniques for treatment of low back pain and lower extremity pain due to contained herniated discs. Only 1 study to date has examined its effect on functional activity and pain medication use; however, results were not analyzed over time, and recall bias was a limitation. OBJECTIVE: Evaluation of the effect of Nucleoplasty on pain and opioid use in improving functional activity in patients with radicular or axial low back pain secondary to contained herniated discs...
March 2007: Pain Physician
Slavica Jandrić, Branislav Antić
INTRODUCTION: Various clinical conditions can cause low back pain, and in most cases it is of a degenerative origin. Degenerative disc disease is a common condition which affects young to middle-aged men and women equally. Changes in the mechanical properties of the disc lead to degenerative arthritis in the intervertebral joints, osteophytes, and narrowing the intervertebral foramen or the spinal canal. PATHOPHYSIOLOGY: Degenerative cascade, described by Kirkaldy-Willis, is the widely accepted pathophysiologic model describing the degenerative process as it affects the lumbar spine in 3 phases...
September 2006: Medicinski Pregled
Richard Derby, John J Lettice, Thomas A Kula, Sang-Heon Lee, Kwan-Sik Seo, Byung-Jo Kim
OBJECT: The authors examined the effect of psychological and emotional status on the outcome in patients with suspected chronic discogenic low-back pain (LBP) who have undergone lumbar fusion. METHODS: The authors retrospectively analyzed the medical records, including the results of the 36-item Short Form (SF-36), of 57 consecutive patients (mean age 42.7 years) who underwent single-level lumbar reconstructive surgery between 1994 and 2000. The SF-36 physical component summary (PCS) and mental component summary (MCS) domains were evaluated...
October 2005: Journal of Neurosurgery. Spine
Mark Laslett, Birgitta Oberg, Charles N Aprill, Barry McDonald
BACKGROUND CONTEXT: The "centralization phenomenon" (CP) is the progressive retreat of referred pain towards the spinal midline in response to repeated movement testing (a McKenzie evaluation). A previous study suggested that it may have utility in the clinical diagnosis of discogenic pain and may assist patient selection for discography and specific treatments for disc pain. PURPOSE: Estimation of the diagnostic predictive power of centralization and the influence of disability and patient distress on diagnostic performance, using provocation discography as a criterion standard for diagnosis, in chronic low back pain patients...
July 2005: Spine Journal: Official Journal of the North American Spine Society
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