- Axial pain +/- radiculopathy: DDD often presents with axial LBP with or without radicular symptoms from a disk herniation.
- Paraspinal muscle spasm: Spasm of the paraspinous muscles may be a major component. Symptoms typically worsen with activity and are improved by lying still, at least briefly.
- Positive straight leg raise test: With a herniated disk, the straight leg raise test may be positive.
- L4-5 and L5-S1 herniations more common: Disk herniations most commonly affect L4-5, but L5-S1 are also routinely involved. Therefore, dermatomal and myotomal patterns often reflect an L5 or S1 radiculopathy.
- Cauda equina syndrome: Patients present with profound weakness or symptoms/signs of cauda equina (weakness, sensory deficits, bowel or bladder dysfunction).
Progression of Symptoms
- Increased severity with recurrence: The increase from the pediatric prevalence of 1.1–66% to 60–80% of adults having experienced back pain suggests a recurrent and increasing prevalence with time (1, 29). Most cases of initial onset LBP last less than a week and are not as severe (20, 21), but LBP often worsens in intensity with recurrence.
- Natural clinical course of herniated disk: Although the natural history of disk herniations is poorly understood, several adult series have suggested that 90% or more improve with conservative therapy (16,22). The largest pediatric series to date showed a slightly worse response rate than reported in the adult literature but suggested it was a reasonable initial response (5).
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