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Management of Symptomatic Lumbar Degenerative Disk Disease

Dr. Madigan is Attending Physician, Knoxville Orthopedic Clinic, Knoxville, TN. Dr. Vaccaro is Professor, Departments of Orthopaedic Surgery and Neurosurgery, Thomas Jefferson University and The Rothman Institute, Philadelphia, PA. Dr. Spector is Attending Physician, OrthoCarolina Spine Center, Charlotte, NC. Dr. Milam is Attending Physician, OrthoCarolina Spine Center.

Reprint requests: Dr. Madigan, Knoxville Orthopedic Clinic, 260 Fort Sanders West Boulevard, Building #6, Knoxville, TN 37922.

Dr. Vaccaro serves as a board member, owner, officer, or committee member for the American Spinal Injury Association, North American Spine Society, AO North America, Computational Biodynamics, Progressive Spinal Technology, and Applied Spinal Technology; is a member of a speakers bureau or has made paid presentations on behalf of Stryker, Medtronic Sofamor Danek, and DePuy; is a paid consultant for Biomet, DePuy, Medtronic Sofamor Danek, Orthofix, Stryker, Thieme, and Vertilink; has received research or institutional support from AO North America, DePuy, Medtronic Sofamor Danek, and Stryker; has received royalties from Aesculap/B. Braun, Biomet, DePuy, Globus Medical, Lippincott, Medtronic Sofamor Danek, Stryker, Thieme, and K2 Spine; has stock or stock options in Globus Medical, Disc Motion Technology, Zygoloc, Vertebron, Progressive Spinal Technologies, Computational Biodynamics, Stout Medical, Paradigm Spine, K-2 Medical, Replication Medica, Spinology, Osteotech, Applied Spinal Technology, Spine Medica, Orthovita, Vertilink, Small Bone Technologies, NeuCore, Crosscurrent, Syndicom, In Vivo, Flagship Surgical, and Pearl Driver; and has or has not received financial or material support from the medical or orthopaedic publications Spine and Journal of Neurosurgery Spine. Dr. Milam or a member of his immediate family has received research or institutional support from Synthes; is a paid consultant and is a member of a speakers bureau or has made paid presentations on behalf of Stryker and Synthes; has received royalties from Stryker; and has stock or stock options in Pioneer Surgical. None of the following authors or a member of their immediate families has received anything of value from or owns stock in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Madigan and Dr. Spector.

None of the following authors or a member of their immediate families has received anything of value from or owns stock in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Sankar, Dr. Weiss, and Dr. Skaggs.

Wudbhav Sankar, MD, et al

Reprint requests: Dr. Skaggs, Children’s Hospital Los Angeles, 4650 Sunset Boulevard, Mail Stop 69, Los Angeles, CA 90027.

Symptomatic lumbar degenerative disk disease, or discogenic back pain, is difficult to treat. Patients often report transverse low back pain that radiates into the sacroiliac joints. Radicular or claudicatory symptoms are generally absent unless there is concomitant nerve compression. Physical examination findings are often unremarkable. Radiographic examination may reveal disk space narrowing, end-plate sclerosis, or vacuum phenomenon in the disk; magnetic resonance imaging is useful for revealing hydration of the disk, annular bulging, or lumbar spine end-plate (Modic) changes in the adjacent vertebral bodies. The use of diskography as a confirmatory study remains controversial. Recent prospective, randomized trials and meta-analyses of the literature have helped expand what is known about degenerative disk disease. In most patients with low back pain, symptoms resolve without surgical intervention; physical therapy and nonsteroidal anti-inflammatory drugs are the cornerstones of nonsurgical treatment. Intradiskal electrothermal treatment has not been shown to be effective, and arthrodesis remains controversial for the treatment of discogenic back pain. Nucleus replacement and motion-sparing technology are too new to have demonstrated long-term data regarding their efficacy.