Degenerative Disk Disease Clinical Presentation

Updated: Feb 06, 2017
  • Author: Stephen Kishner, MD, MHA; Chief Editor: Jeffrey A Goldstein, MD  more...
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Presentation

History and Physical Examination

This cascade of degenerative changes seen in this disease can be subdivided into the following three stages:

  • Dysfunction
  • Instability
  • Restabilization

The duration of the stages varies greatly, and distinguishing the signs and symptoms from one stage to the next is difficult.

Dysfunction involves outer annular tears and separation of the endplate, cartilage destruction, and facet synovial reaction. The symptoms of dysfunction are low back pain or neck pain, often localized but sometimes referred, and painful movement. The signs are local tenderness, contracted muscles, hypomobility, and painful extension of the back, neck, or both. Results of a neurologic examination are usually normal.

The dysfunction stage is followed by the instability stage, in which disk resorption and loss of disk space height occur. Facet capsular laxity may develop, leading to subluxation. The symptoms are those of dysfunction (ie, "giving way" of the back, a "catch" in the back with movement, and pain with standing after flexion). The signs are abnormal movement (ie, during inspection or palpation), including observation of a catch, sway, or shift when standing erect after flexion. It has been found that the release of cytokines play a key role in all three stages and will likely be a target for therapeutic interventions in the future.

In the stage of restabilization, the progressive degenerative changes lead to osteophyte formation and stenosis. The symptoms are low back pain of decreasing severity. The signs are muscle tenderness, stiffness, reduced movement, and scoliosis.