Degenerative Disc Disease Flashcards
What is degenerative disc disease
Natural deterioration of the IVD structure such that they become weaker and begin to collapse
What factors precipitate IVD degeneration
Dehydration of the nucleus pulposus
Daily activities causing tears in the annulus fibrosis
Injuries leading to instability of the spine
What are the three stages of degenerative disc disease
Dysfunction
Instability
Restabilisation
what are the clinical features of degenerative disc disease
Local spinal tenderness
Contracted paraspinal muscles
Hypomobility
May be neurological sx
In severe cases can cause radicular leg pain/paraesthesia
What is the Lasègue test
Also known as the straight leg raise - used to assess disc herniation
How to:
Pt lies flat and examiner raises pts leg up with knee extended. +ve if pain experienced/ cervical spine flexion
What are the differential diagnoses to consider
Cauda equina
Infection
Malignancy
what are the red flag signs
New onset faecal/urinary incontinence
Saddle anaesthesia
immunosuppression or chronic steroid use, intravenous drug abuse, unexplained fever, significant trauma, osteoporosis or metabolic bone disease, new onset after 50 years old, or a history of malignancy.
What are the guidelines on when pts should get a imaging investigation
Red flags present
Radiculopathy for more than 6 weeks
Spinal cord compression
Imaging would alter management
What is the gold standard investigation for pts suspected with degenerative disc disease
MRI spine
If looks normal on MRI then the spine is not causing problems, investigate other possible causes
What is the management of degenerative disc disease in acute disease states
Adequate pain relief
Simple analgesics should be used first-line, with neuropathic analgesics as adjuncts if required.
Encourage mobility
Physiotherapy
What is the management of degenerative disc disease if pain continues past 3 months of analgesia
Referral to pain clinic
No evidence that surgery improves symptoms
