Discogenic Syndromes Overview

Discogenic Syndromes

• Causes:
  • Degeneration of the intervertebral disc due to microtrauma and potential autoimmune reactions.
  • Tears in the annulus fibrosis, which don't heal well.
  • Activities and postures increasing intradiscal pressure, like flexion, rotation, lifting, and prolonged sitting, can cause the nucleus to protrude.
  • Inflammation, bulging, and protrusion of the disc can irritate or compress nerve roots.
  • A degenerated disc is a "weak link" and can deteriorate under prolonged or repeated stress.

Discogenic Syndromes History

• Onset can be rapid or slow, with potential for previous episodes.
• Precipitating activities include flexion, rotation, lifting objects, prolonged sitting, jarring activities, falls, and a weak immune system.
• Discs are particularly vulnerable in the early mornings.

Discogenic Syndromes Signs and Symptoms

• Area:
  • Pain location depends on the structures involved.
  • Dura: pain around the affected area, central and paravertebral.
  • Posterior longitudinal ligament (PLL): Central or referred pain.
  • Nerve root sleeve: Central pain localized to one side.
  • Nerve root: Pain that is distal, defines, and follows a dermatome pattern.
• Character:
  • Pain may be deep (non-nerve root) or superficial, clearly defining a nerve root involvement.
  • Severe inflammation can cause unbearable, distressing, and sickening pain.
  • Neurological symptoms can occur if the nerve root is involved.
• Behavior:
  • Aggravating factors include:
    • Activities and postures that increase intradiscal pressure.
    • Sneezing, coughing, and Valsalva maneuver.
  • Easing factors include:
    • Lying down or decreasing pressure.
• Protective Deformities:
  • Protective muscle spasms can lead to scoliosis, kyphosis, or list.

Discogenic Syndromes Perpetuating Factors

• Structural:
  • Weak abdominal stabilizers: affect intra-abdominal pressure.
  • Kyphosis, lordosis, and scoliosis.
  • Abnormal gait due to leg length discrepancies.
• Ergonomic:
  • Chair and table design.
  • Poor workspace, including repetitive flexion and rotation tasks.
• Activities:
  • Activities that increase intra-abdominal pressure.
• Stress:
  • Fatigue can reduce immune system function.
• Disease:
  • Viral infections.
  • Scheuermann's disease.
  • Autoimmune diseases.
  • Endplate fractures.

Discogenic Syndromes Treatment

• Spinal mobilization techniques. Avoid PA mobilization if extension is the worst symptom.
• Lumbar stabilization exercises (local and global).
• Treatment of associated trigger points (search widely).
• Neural tissue mobilization.
• Education about:
  • Pathology.
  • Avoiding postures and activities that increase intradiscal pressure.
  • Kinetic handling.
  • Ergonomics.

Special Discogenic Cases: "Flat Tyre Syndrome"

• Cause:
  • Disc space narrowing due to degeneration or disc prolapse.
  • Ligaments and capsule haven't adapted to the height of the intervertebral segment.
• History:
  • Slow or rapid onset with a precipitating jerky accident.
  • Previous episodes of disc degeneration.
  • Acceleration of wear and tear due to work or hobbies.
• Signs and Symptoms:
  • Area: Local or referred pain, depending on the involvement and severity of instability.
  • Character: Catching pain, twingy, stabbing, unexpected pain, and a feeling of weakness in the back.
  • Behavior:
    • Aggravating factors: Prolonged standing, walking, lying, extension exercises, arc of pain with flexion, extension out of flexion (difficult and painful), palpation (provoke pain).
    • Easing factors: Stable positions (sitting aggravates symptoms if there is a disc lesion).
  • Protective Deformities: Depend on the structures involved.
• Perpetuating Factors:
  • Structural: Trunk stability, general degeneration (if more than one level is involved).
  • Activities and Posture: Activities with quick movements, a large range of motion (ROM), jarring, especially into extension.
  • Stress: Unconscious use of the body.
• Treatment:
  • Spinal mobilization techniques.
  • Spinal stability exercises.
  • Neural mobility.
  • Education:
    • Pathology.
    • Avoiding jerky, twisting, jarring activities.
    • Avoiding extension postures and activities (if antero displacement).
    • Central stability.
    • Educate about cord/cauda equina signs and symptoms.

Juvenile Disc Syndrome

• Affects more young men than women.
• Symptoms include mild spinal stiffness, muscle spasm, and joint signs out of proportion.
• Lumbar flexion deformity is common, often retained with prone lying.
• Palpation reveals little until strong grade IV/V pressure is applied, resulting in severe pain.
• Marked limitation with flexion and SLR.
• Treatment Aim: Lessen pain rather than increase ROM.

This quiz covers the causes, history, and signs of discogenic syndromes. You'll learn about factors contributing to disc degeneration and the symptoms associated with nerve irritation. Perfect for students and practitioners in health sciences.