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Degenerative disc disease

Last updated: June 17, 2021

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Degenerative disc disease refers to a variety of pathologies involving displacement of disc material into the spinal canal, such as protrusion, herniation, and sequestration. Degenerative disc disease results in mechanical compression of either the spinal cord or a nerve root. The most common symptoms of disc disease are radicular pain in the dermatome of the compressed nerve root, muscle weakness, and loss of deep tendon reflexes in the indicator muscles. The location of the lesion can often be determined using the patient's neurological deficits. In most cases of lumbosacral disc disease, L5 nerve compression is present, which leads to reduced sensitivity in the lateral leg, dorsum of the foot, and weakness in extending the big toe. A protruded/herniated disc on MRI confirms the diagnosis. Conus medullaris syndrome and cauda equina syndrome are severe forms of disc herniation that may present with paresis, sensory deficits, and urinary and bowel incontinence. They require urgent decompression via surgical intervention. Most spinal disc herniations, however, can be treated conservatively with analgesia and by maintaining physical activity.

  • Age: most common at 30–50 years
  • Sex: > [1]
  • Approx. 80% of all Americans suffer from significant back pain at some point in their lives. [2]
  • Disc herniation is the cause of back pain in roughly 5% of cases.

Epidemiological data refers to the US, unless otherwise specified.

General clinical features

A sudden decrease in pain concomitant with an increase in the degree of paralysis can be a warning sign of neuronal death.

Common radiculopathies

Overview of radiculopathies
Radiculopathy Level of lesion Sensory deficits Motor deficits Reduction of reflexes
C3/4 radiculopathy
  • C2–C4
  • Shoulder and neck area
  • None
C5 radiculopathy
  • C4–C5
C6 radiculopathy
  • C5–C6
  • From upper lateral elbow over radial forearm up to thumb and radial side of index finger
C7 radiculopathy
  • C6–C7
  • Palmar: fingers II–IV (II ulnar half, III entirely, IV radial half)
  • Dorsal: medial forearm up to fingers II–IV
  • Triceps and wrist flexors, finger extensors
C8 radiculopathy
  • C7–C8
  • Finger flexors
  • None
L3 radiculopathy
  • L2–L3
L4 radiculopathy
  • L3–L4
  • Extending from distal anterolateral thigh area over patella up to inner side of lower leg
L5 radiculopathy
  • L4–L5
  • Lateral sides of thigh and knee, anterolateral lower leg, dorsum of foot, big toe
S1 radiculopathy
  • L5–S1
  • Dorsolateral thigh, dorsolateral lower leg, lateral foot

S2 radiculopathy, S3 radiculopathy, S4 radiculopathy

  • None

Spinal cord compression

Other types of degenerative disc disease

Overview of conus medullaris syndrome and cauda equina syndrome
Syndrome Etiology Onset Pain Motor symptoms Sensory symptoms Urogenital and rectal symptoms
Conus medullaris syndrome
  • Sudden, bilateral
  • Symmetric, bilateral perianal numbness
  • Sensory dissociation
Cauda equina syndrome
  • Damage to or compression of the cauda equina with nerve fibers of L3–S5 (below L2)
  • Gradual, unilateral
  • Saddle anesthesia: lack of sensitivity in the dermatomes S3–S5, affecting the areas around the anus, genitalia, and inner thighs (may be asymmetric)
  • Asymmetric, unilateral numbness and/or paresthesia in lower limb dermatomes

Conus medullaris syndrome and cauda equina syndrome are medical emergencies requiring immediate surgical intervention.


See “Acute back pain” for details on the distinguishing characteristics and management of the underlying etiology.

Acute spinal cord compression is a surgical emergency. Obtain immediate MRI or CT myelography, give IV steroids for malignant compression, and decompress the cord (e.g., with surgery) as soon as possible!

The differential diagnoses listed here are not exhaustive.

Conservative treatment

Up to 80% of all disc herniations are self-limiting and usually resolve within 4 weeks.

Surgical treatment

  1. Wang Y-XJ, Griffith JF, Zeng X-J, et al. Prevalence and Sex Difference of Lumbar Disc Space Narrowing in Elderly Chinese Men and Women: Osteoporotic Fractures in Men (Hong Kong) and Osteoporotic Fractures in Women (Hong Kong) Studies. Arthritis & Rheumatism. 2013; 65 (4): p.1004-1010. doi: 10.1002/art.37857 . | Open in Read by QxMD
  2. Freburger JK, Holmes GM, Agans RP, et al. The rising prevalence of chronic low back pain.. Arch Intern Med. 2009; 169 (3): p.251-8. doi: 10.1001/archinternmed.2008.543 . | Open in Read by QxMD
  3. Bhandutia AK, Winek NC, Tomycz ND, Altman DT. Traumatic Conus Medullaris Syndrome. JBJS Case Connector. 2016; 6 (2): p.e38. doi: 10.2106/ . | Open in Read by QxMD
  4. Brouwers E, van de Meent H, Curt A, Starremans B, Hosman A, Bartels R. Definitions of traumatic conus medullaris and cauda equina syndrome: a systematic literature review. Spinal Cord. 2017; 55 (10): p.886-890. doi: 10.1038/sc.2017.54 . | Open in Read by QxMD
  5. Eisen A, Aminoff MJ, Wilterdink JL. Anatomy and Localization of Spinal Cord Disorders. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. updated: November 18, 2015. Accessed: July 11, 2017.
  6. Schiff D, Brown P, Shaffrey ME, DeAngelis LM, Eichler AF, Savarese DMF. Treatment and Prognosis of Neoplastic Epidural Spinal Cord Compression, including Cauda Equina Syndrome. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. updated: June 27, 2017. Accessed: September 14, 2017.