Degenerative Disk Disease Clinical Presentation

Updated: Mar 15, 2019
  • Author: Stephen Kishner, MD, MHA; Chief Editor: Jeffrey A Goldstein, MD  more...
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Presentation

History and Physical Examination

The cascade of degenerative changes seen in degenerative disk 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.

The dysfunction stage 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.

In the instability stage, 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. 

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

It has been found that the release of cytokines plays a key role in all three stages; this represents a likely target for future therapeutic interventions.