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Lumbar (Intervertebral) Disk Disorders Treatment & Management

  • Author: Jere F Baldwin, MD; Chief Editor: Trevor John Mills, MD, MPH  more...
 
Updated: Feb 18, 2016
 

Prehospital Care

Little is needed in the way of prehospital care. Appropriate spinal immobilization should be considered if the patient has evidence of trauma; otherwise, simple transportation in the position of comfort is all that is indicated.

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Emergency Department Care

Patients should lie in a position in which they are most comfortable.

Muscle relaxants are of limited use, and clinical studies have not proven their efficacy. This class includes benzodiazepines, methocarbamol, and cyclobenzaprine. Patients should be warned that all of these drugs are sedating. Opioids provide very effective acute pain relief, but they should not be used in patients with chronic pain. Salicylates, acetaminophen, and nonsteroidal anti-inflammatory drugs (NSAIDs) all have been used in the treatment of pain from lumbar disk disease, but none of these has been shown to be superior to the others. Acetaminophen lacks anti-inflammatory activity.[8, 9]

Of 76 patients who presented to an emergency department with low back pain, 42 (55%) had resolution or return of pain to baseline with conservative management; 18 (24%) had improvement with intervention (epidural steroid injection or kyphoplasty); 8 (10%) improved with surgery; and 8 had persistent pain (11%).[10]

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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, 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.

Specialty Editor Board

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

Disclosure: Received salary from Medscape for employment. for: Medscape.

David B Levy, DO, FAAEM Senior Consultant in Emergency Medicine, Waikato District Health Board, New Zealand; Associate Professor of Emergency Medicine, Northeastern Ohio Universities College of Medicine

David B Levy, DO, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, Fellowship of the Australasian College for Emergency Medicine, American Medical Informatics Association, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Trevor John Mills, MD, MPH Chief of Emergency Medicine, Veterans Affairs Northern California Health Care System; Professor of Emergency Medicine, Department of Emergency Medicine, University of California, Davis, School of Medicine

Trevor John Mills, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians

Disclosure: Nothing to disclose.

Additional Contributors

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, Ohio State Medical Association

Disclosure: Nothing to disclose.

References
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  2. 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. 2003 Jun 4. 289(21):2810-8. [Medline].

  3. Björnsdóttir S, Jónsson S, Valdimarsdóttir U. Functional limitations and physical symptoms of individuals with chronic pain. Scand J Rheumatol. 2012 Nov 6. [Medline].

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

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

  6. 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. 1994 Jul 14. 331(2):69-73. [Medline].

  7. El Barzouhi A, Verwoerd AJ, Peul WC, Verhagen AP, Lycklama À Nijeholt GJ, Van der Kallen BF, et al. Prognostic value of magnetic resonance imaging findings in patients with sciatica. J Neurosurg Spine. 2016 Feb 12. 1-8. [Medline].

  8. Radcliff K, Freedman M, Hilibrand A, Isaac R, Lurie JD, Zhao W, et al. Does Opioid Pain Medication Use Affect the Outcome of Patients with Lumbar Disk Herniation?. Spine (Phila Pa 1976). 2013 Apr 15. [Medline].

  9. Eskin B, Shih RD, Fiesseler FW, Walsh BW, Allegra JR, Silverman ME, et al. Prednisone for emergency department low back pain: a randomized controlled trial. J Emerg Med. 2014 Jul. 47 (1):65-70. [Medline].

  10. Rao S, Rao S, Harvey HB, Avery L, Saini S, Prabhakar AM. Low back pain in the emergency department-are the ACR Appropriateness Criteria being followed?. J Am Coll Radiol. 2015 Apr. 12 (4):364-9. [Medline].

  11. Patel S, Psychol C, Friede T, Froud R, Evans DW, Underwood M. Systematic review of randomised controlled trials of clinical prediction rules for physical therapy in low back pain. Spine (Phila Pa 1976). 2012 Nov 5. [Medline].

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

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

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

  15. Willems PC, Staal JB, Walenkamp GH, de Bie RA. Spinal fusion for chronic low back pain: systematic review on the accuracy of tests for patient selection. Spine J. 2012 Nov 2. [Medline].

  16. 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. 2006 Nov 22. 296(20):2441-50. [Medline].

  17. 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. 2006 Nov 22. 296(20):2451-9. [Medline].

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

  19. 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. 2004 May. 231(2):343-51. [Medline].

 
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