Lumbar disk disease: pathophysiology, management and prevention

Patients with symptomatic lumbar disk disease may present with back pain, referred leg pain, radicular leg pain, sensory changes and leg weakness. Because neurologic deficits are commonly localized to the L5 or S1 nerve roots, evaluation of patients with such symptoms should focus on these dermatomes and muscle groups. Myelography, computed tomography, postmyelogram computed tomography and magnetic resonance imaging are the most valuable diagnostic studies. Initial management consists of physical therapy and reduced activity, followed by gradually increasing mobilization and exercise. Conservative treatment is effective for most patients. Surgical treatment is reserved for patients who have failed to improve with conservative therapy or those who present with a profound neurologic deficit. Prevention of recurrent symptoms centers on patient education and reassurance. A program of weight control, regular exercise and posture correction may reduce the frequency and severity of recurrent disk herniation and pain.