Intervertebral Disc Herniation
An acute herniated intervertebral disk can result from stress or trauma to the spine or degeneration with age. A herniated disc occurs when the nucleus pulposus (gelatonous centre of the disc) ruptures, causing acute back pain. The pain may be caused by the compression of nerve roots by the herniated disc ( Brown & Edwards 2005). The patient may require discectomy or laminectomy if symptoms (radiating pain and numbness) are not relieved by non-surgical methods with 6 weeks (Strayer 2006).
Cauda Equina Syndrome (CES)
Results form damage to the conus (lowest portion of the spinal cord) and the cauda equina (lumbar and sacral nerve roots). This injury may result in flaccid paralysis of the lower limbs as well as flaccid bladder and bowel (Brown & Edwards 2005). Symptoms can occur suddenly without any previous history of backache; or can be gradual in onset. The patient may require surgery (laminectomy or discectomy); Surgery is recommended within 48 hours of the patients presentation (Strayer 2006).
Lumbar Stenosis
Spinal canal stenosis is most commonly caused by spondylosis (Devereaux 2009). It occurs when the spinal canal becomes flattened and as it progresses the cauda equina is compressed. Laminectomy and partial facetectomy is the standard surgery for lumbar stenosis (Strayer 2006).
Spondylosis
Spondylosis is a term used for degenerative changes, occurring naturally during the ageing process. These changes occur particularly in the lumbar spine; this is because this part of the spine is more mobile (Devereaux 2009). These degenerative changes affect the discs, facet joints, surrounding soft tissue, vertebrae, ligaments and articular processes. Spondylosis may be asymptomatic, or the patient may experience chronic or acute low back pain. If the patient needs surgical intervention, lumbar fusion is required (Strayer 2006).
Degenerative Disc Disease
Degenerative disc disease (DDD) is a change in the composition and function of the disc. This occurs with age as the water content of the disc and vascularity of the disc decrease. By the age of 30, the disc provide less support and resistance to movement. The nucleus pulposus will become less elastic with age, as well as tears developing in the annulus fibrosis. The disc may become painful if the outer third is exposed to noxious stimuli, leading to symptoms including pain and disability. If surgical intervention is necessary, lumbar fusion is required (Strayer 2006).