What are the North American Spine Society guidelines for the diagnosis and treatment of lumbar disc disease?

Updated: Sep 25, 2018
  • Author: Kamran Sahrakar, MD, FACS; Chief Editor: Brian H Kopell, MD  more...
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Answer

The following guidelines were published by the North American Spine Society [33] :

Manual muscle testing, sensory testing, supine straight leg raise, Lasegue's sign, and crossed Lasegue's sign are recommended for use in diagnosing lumbar disc herniation with radiculopathy. The supine straight leg raise, as compared with the seated straight leg raise, is suggested for use in diagnosing lumbar disc herniation with radiculopathy.

In patients with a history and physical examination findings consistent with lumbar disc herniation with radiculopathy, MRI is considered as the most appropriate, noninvasive test to confirm the presence of lumbar disc herniation. If MRI is econtraindicated or inconclusive, CT or CT myelography is the next most appropriate test..

Contrast-enhanced fluoroscopy is recommended to guide epidural steroid injections to improve accuracy of medication delivery.

Transforaminal epidural steroid injection is recommended to provide short-term (2–4 wk) help provide pain relief in patients with lumbar disc herniations with radiculopathy.

Endoscopic percutaneous discectomy is suggested for carefully selected patients to reduce early postoperative disability and reduce opioid use, as compared with open discectomy in the treatment of patients with lumbar disc herniation with radiculopathy.

If surgery is indicated, sequestrectomy or aggressive discectomy is recommended for decompression in patients with lumbar disc herniation with radiculopathy because there is no difference in rates of reherniation.


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