Nursing review section of surgical neurology international: Part 1 lumbar disc disease

BACKGROUND: Patients with lumbar disc disease may present with low back pain, pain that radiates down into the lower extremity (radiculopathy), and leg pain that increases with ambulation (neurogenic claudication). Patients may first undergo diagnostic studies [(magnetic resonance imaging (MRI) and computed tomographic (CT) examinations] to determine whether there is any significant nerve root or thecal sac compression. METHODS: Increasingly, patients with low back pain with/without radiculopathy are being screened by nurses rather than by neurologists or neurosurgeons/orthopedists. Recognition of the basic neurological symptoms and signs of lumbar disc disease is critical to manage and triage these patients. RESULTS: The neurological examination includes evaluation of the straight leg raising test [straight leg raise (SLR)/Lasegue Maneuver], and assessment of: motor function [grade 0 (no motion) to 5 (normal motion)], reflexes [patellar and Achilles levels graded 0 (absent) to 4+ (clonus)], sensory loss (pin prick, light touch, position, and vibration), and cerebellar function (tandem gait, heel-shin, and finger-nose-finger). Learning to read MR and CT studies for disc herniations is critical. Nonsurgical discs include those that are minimally protruding or bulging. Alternatively, surgical disc herniations are extruded (ruptured through the annulus) or sequestrated (migrated beyond the disc space following rupture). CONCLUSION: Familiarity with symptoms, neurological signs, and radiographic presentation for patients with lumbar disc disease is critical for nurses. Here we review the important factors nurses should know to better recognize/triage, and treat patients with lumbar disc disease.