Lumbar Disc Disease Workup

  • Author: Kamran Sahrakar, MD, FACS; Chief Editor: Allen R Wyler, MD   more...
 
Updated: Nov 3, 2011
 

Imaging Studies

  • MRI is by far the most commonly ordered test to evaluate patients with sciatica.
    • Often, MRI is performed prior to plain radiographs.
    • MRI is very sensitive in delineating lumbar disc herniations. Far lateral discs are best evaluated with this test.
    • In reoperations, MRI can delineate the full extent of scar tissue and, with moderate reliability, differentiate it from recurrent disc herniation.
  • CT scan myelography may be preferred by surgeons for evaluating patients before reoperation or for evaluating patients who have severely spondylotic changes. This is because CT scan myelography can delineate bony structures better than MRI.
  • Plain radiographs, especially with weight-bearing flexion and extension views, can be a useful adjunct to other radiographic evaluations. Some spine tumors, instabilities, malalignments, and congenital anomalies can be identified best with plain radiographs. Obtain plain films on all patients prior to surgery.
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Other Tests

Electromyography is rarely helpful in the diagnosis or management of lumbar disc disease. Occasionally, a diabetic patient can be identified as having a polyradiculopathy or plexopathy. On this basis, some surgeons proceed to surgery with more caution.

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Histologic Findings

Some surgeons continue to submit disc material for histologic diagnosis. The yield of this is exceedingly low and of questionable benefit.

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Contributor Information and Disclosures
Author

Kamran Sahrakar, MD, FACS  Clinical Professor, Department of Neurosurgery, University of California at San Francisco

Kamran Sahrakar, MD, FACS is a member of the following medical societies: Alpha Omega Alpha, American Association of Neurological Surgeons, American Medical Association, California Medical Association, Florida Medical Association, and Nevada State Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

Martin Melicharek, MD  Assistant Clinical Professor, Department of Neurosurgery, University of California at Davis

Martin Melicharek, MD is a member of the following medical societies: American Association of Neurological Surgeons, California Medical Association, and Ohio State Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Michael G Nosko, MD, PhD  Associate Professor of Surgery, Chief, Division of Neurosurgery, Medical Director, Neuroscience Unit, Medical Director, Neurosurgical Intensive Care Unit, Director, Neurovascular Surgery, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School

Michael G Nosko, MD, PhD is a member of the following medical societies: Academy of Medicine of New Jersey, Alpha Omega Alpha, American Association of Neurological Surgeons, American College of Surgeons, American Heart Association, American Medical Association, Canadian Congress of Neurological Sciences, Congress of Neurological Surgeons, New York Academy of Sciences, and Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Allen R Wyler, MD  Former Medical Director, Northstar Neuroscience, Inc

Allen R Wyler, MD is a member of the following medical societies: American Academy of Neurological and Orthopaedic Surgeons, American Association of Neurological Surgeons, and Society of Neurological Surgeons

Disclosure: Nothing to disclose.

Paolo Zamboni, MD  Professor of Surgery, Chief of Day Surgery Unit, Chair of Vascular Diseases Center, University of Ferrara, Italy

Paolo Zamboni, MD is a member of the following medical societies: American Venous Forum and New York Academy of Sciences

Disclosure: Nothing to disclose.

Chief Editor

Allen R Wyler, MD  Former Medical Director, Northstar Neuroscience, Inc

Allen R Wyler, MD is a member of the following medical societies: American Academy of Neurological and Orthopaedic Surgeons, American Association of Neurological Surgeons, and Society of Neurological Surgeons

Disclosure: Nothing to disclose.

References

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Degenerative lumbar disc disease. The various forces placed upon the discs of the lumbar spine that can result in degenerative changes.
 
 
 
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