Herniated disk
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A herniated disk is defined as "an intervertebral disk in which the nucleus pulposus has protruded through surrounding fibrocartilage. This occurs most frequently in the lower lumbar region.".[1]
A herniated disk is an infrequent, but important cause of low back pain. A herniated disk is more likely when sciatica is present.
Diagnosis
History and physical examination
The presence of sciatica is associated with a herniated disk:[2]
- sensitivity = 95%
- specificity = 88%
On physical examination, a positive straight leg raise is associated with a herniated disk:[2]
- sensitivity = 80%
- specificity = 40%
Treatment
A randomized controlled trial of discectomy versus conservative care found the surgery led to quicker improvement, but there were no differences after one year.[3] The cost of surgery might be acceptable to some patients.[4]
References
- ↑ National Library of Medicine. Intervertebral Disk Displacement. Retrieved on 2007-11-13.
- ↑ 2.0 2.1 Deyo RA, Rainville J, Kent DL (1992). "What can the history and physical examination tell us about low back pain?". JAMA 268 (6): 760–5. PMID 1386391. [e]
- ↑ Peul WC, Hout WB, Brand R, Thomeer RT, Koes BW; for the Leiden-The Hague Spine Intervention Prognostic Study Group. Prolonged conservative care versus early surgery in patients with sciatica caused by lumbar disc herniation: two year results of a randomised controlled trial. BMJ. 2008 May 23. PMID 18502911
- ↑ Hout WB, Peul WC, Koes BW, Brand R, Kievit J, Thomeer RT; for the Leiden-The Hague Spine Intervention Prognostic Study Group. Prolonged conservative care versus early surgery in patients with sciatica from lumbar disc herniation: cost utility analysis alongside a randomised controlled trial. BMJ. 2008 May 23. PMID 18502912