eMedicine Specialties > Emergency Medicine > Trauma & Orthopedics

Lumbar (Intervertebral) Disk Disorders: Follow-up

Author: Jere F Baldwin, MD, Medical Director, Department of Emergency Medicine, Mercy Hospital Port Huron
Coauthor(s): Jeffrey Horwitz, DO, Director, Assistant Clinical Professor, Department of Emergency Medicine, North Shore University Hospital at Forest Hills
Contributor Information and Disclosures

Updated: Jan 28, 2009

Follow-up

Further Inpatient Care

  • Inpatient care generally is not required, except for those rare cases of intractable pain or in cases in which the social situation does not allow adequate home care. Further inpatient care mostly consists of continued analgesics, physical therapy, and possible consultation with a spine specialist.

Further Outpatient Care

  • Patients should lie in a position in which they are most comfortable.
  • Bed rest is not recommended most of the time. The exception is for patients whose pain is so severe that they cannot ambulate.
    • Prolonged immobilization may worsen pain and extend recovery time.
    • Strict bed rest should never exceed 2 days. Patients should be encouraged to begin limited activity as soon as possible.
  • Whether spinal manipulation (ie, chiropractic care) improves the rate of recovery in patients with disk disease is controversial.
  • Multiple surgical techniques have been used in patients with disk herniation who have not responded to 6 weeks of conservative therapy. These techniques include diskectomy, spinal fusion, and injection of chymopapain. Newer techniques continue to be developed.6,7,8
  • The Spine Patient Outcomes Research Trial (SPORT) in 2006 failed to find any statistical superiority of surgical treatment versus conservative treatment for lumbar disk herniation.9,10 This occurred because the study design allowed crossover of treatment based on the patients' preference. These findings suggest that, in most cases, there is no clear reason to advocate for surgery apart.  Patient choice appears to be the most important predictive factor.

Deterrence/Prevention

  • Smoking cessation
  • Weight reduction
  • Improve general physical condition
  • Avoid aggravating factors

Complications

Prognosis

  • Most patients can resume normal activities.

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • Failure to consider alternate diagnoses, such as acute vascular, neurologic, malignant, or infectious etiologies, of the patient's pain
  • Failure to adequately advise the patient of warning signs of complications from their diagnosis. These may include loss of bowel or bladder control due to cauda equina syndrome, persistent leg numbness, weakness from a further disk herniation, or other complications.
 


More on Lumbar (Intervertebral) Disk Disorders

Overview: Lumbar (Intervertebral) Disk Disorders
Differential Diagnoses & Workup: Lumbar (Intervertebral) Disk Disorders
Treatment & Medication: Lumbar (Intervertebral) Disk Disorders
Follow-up: Lumbar (Intervertebral) Disk Disorders
References
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References

  1. Gregory DS, Seto CK, Wortley GC, Shugart CM. Acute lumbar disk pain: navigating evaluation and treatment choices. Am Fam Physician. Oct 1 2008;78(7):835-42. [Medline].

  2. Deen HG Jr. Diagnosis and management of lumbar disk disease. Mayo Clin Proc. Mar 1996;71(3):283-7. [Medline].

  3. Deyo RA. Diagnostic evaluation of LBP: reaching a specific diagnosis is often impossible. Arch Intern Med. Jul 8 2002;162(13):1444-7; discussion 1447-8. [Medline].

  4. Jarvik JG, Hollingworth W, Martin B, et al. Rapid magnetic resonance imaging vs radiographs for patients with low back pain: a randomized controlled trial. JAMA. Jun 4 2003;289(21):2810-8. [Medline].

  5. Jensen MC, Brant-Zawadzki MN, Obuchowski N, et al. Magnetic resonance imaging of the lumbar spine in people without back pain. N Engl J Med. Jul 14 1994;331(2):69-73. [Medline].

  6. Carragee E. Surgical treatment of lumbar disk disorders. JAMA. Nov 22 2006;296(20):2485-7. [Medline].

  7. Deyo RA, Gray DT, Kreuter W, et al. United States trends in lumbar fusion surgery for degenerative conditions. Spine. Jun 15 2005;30(12):1441-5; discussion 1446-7. [Medline].

  8. Dullerud R, Nakstad PH. CT changes after conservative treatment for lumbar disk herniation. Acta Radiol. Sep 1994;35(5):415-9. [Medline].

  9. [Best Evidence] Weinstein JN, Tosteson TD, Lurie JD, et al. Surgical vs nonoperative treatment for lumbar disk herniation: the Spine Patient Outcomes Research Trial (SPORT): a randomized trial. JAMA. Nov 22 2006;296(20):2441-50. [Medline].

  10. Weinstein JN, Lurie JD, Tosteson TD, et al. Surgical vs nonoperative treatment for lumbar disk herniation: the Spine Patient Outcomes Research Trial (SPORT) observational cohort. JAMA. Nov 22 2006;296(20):2451-9. [Medline].

  11. Frost H, Lamb SE, Doll HA, et al. Randomised controlled trial of physiotherapy compared with advice for low back pain. BMJ. Sep 25 2004;329(7468):708. [Medline].

  12. Gilbert FJ, Grant AM, Gillan MG, et al. Low back pain: influence of early MR imaging or CT on treatment and outcome--multicenter randomized trial. Radiology. May 2004;231(2):343-51. [Medline].

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Further Reading

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Keywords

lumbar disk disorders, lumbar disk disease, low back pain, sciatica, intervertebral disk disorders, back pain, back pain diagnosis, back pain treatment, back pain pictures, back pain x-rays, sciatic nerve, disk herniation, disk bulge, disk protrusion, disk extrusion, disk sequestration, herniated disk

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Contributor Information and Disclosures

Author

Jere F Baldwin, MD, Medical Director, Department of Emergency Medicine, Mercy Hospital Port Huron
Jere F Baldwin, MD is a member of the following medical societies: American Academy of Family Physicians, American College of Emergency Physicians, American Medical Association, Michigan State Medical Society, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

Jeffrey Horwitz, DO, Director, Assistant Clinical Professor, Department of Emergency Medicine, North Shore University Hospital at Forest Hills
Jeffrey Horwitz, DO is a member of the following medical societies: Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Medical Editor

Mark S Slabinski, MD, FACEP, FAAEM, Vice President, EMP Medical Group
Mark S Slabinski, MD, FACEP, FAAEM is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, and Ohio State Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

David B Levy, DO, FACEP, FAAEM, Chairman, Department of Emergency Medicine, St Elizabeth Health Center; Associate Professor of Emergency Medicine, Northeastern Ohio Universities College of Medicine
David B Levy, DO, FACEP, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American Medical Informatics Association, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD, Medical Director, Assistant Professor of Surgery, Section of Emergency Medicine, Yale-New Haven Hospital
Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: WebMD Salary Employment

 
 
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