Lumbar DDD ICD-9
- 722.52 (intervertebral disc disorders; lumbar intervertebral disc)
Lumbar DDD Etiology / Epidemiology / Natural History
- Includes lumbar spondylosis and isloated disk resorption, with degerative chages detectable on plain xrays.
- Associated with repetitive flexion and extension activites such as gymnastics, incidence of DDD increases with length of time athletes competes in gymnastics; up to 63% for Olympic gymnasts.
Lumbar DDD Anatomy
Lumbar DDD Clinical Evaluation
- Midline back pain; referred pain to the sacroiliac joints and posterior thighs. Buttock/thihg pain with ambulation.
- Painful lumbar ROM
- Waddels Signs
Lumbar DDD Xray / Diagnositc Tests
- A/P, lateral, flexion/extensionviews demonstrate disk-space narrowing, end-plate sclerosis, osteophyte formation, facet hypertrophy, spondylosis,
- Segmetnal Instability = 4.5mm or 15 degrees of sagittal displacement on flexion/extension views.
- MRI: High-intensity zones (T2-images) represent annular tears. Loss of normal disc signal dark discs, Modic changes in the end plate and vertebral body.
- Diskography: high-false negatives. Positve result = annular disruption, reproduction of patients symptoms (concordant pain) and negative control levels. Classification of chages = Adams MA, JBJS 1986;68Br36.
Lumbar DDD Classification / Treatment
- Activity limitations, NSAIDS, Physical therapy (Hayden JA, Ann INtern Med 2005;142:765), muscle relaxants, Narcotics, progressive activity.
- No Benefit vs placebo: electrical nerve stimulation, topical magnets, traction, IDET (Freeman BJ, Spine 2005;30:2369).
- Surgical options: ALIF, PLIF, TLIF, Posterior fusion, total disc replacement.
- Epidural corticosteroid injections for radiculopathy can provide reductions in pain and improved function, but the benefits were small and not sustained, and there is no effect on long-term surgery risk. (Chou R, Ann Intern Med. online 25 August 2015 doi:10.7326/M15-0934).
Lumbar DDD Associated Injuries / Differential Diagnosis
- Cauda Equina Syndrome
- Herniated disc
- Lumbar spinal stenosis
Lumbar DDD Complications
Lumbar DDD Follow-up Care
- 91% acceptable outcome for spinal fusion in patients with segmental instability, 43% for discogenic pain confimed by diskigraphy (Carragee EJ, Spine 2006;31:2115).
Lumbar DDD Review References