As you may know, the symptoms provoked by lumbar degenerative disc disease can mimic those caused by other lower back conditions.
To help distinguish between lumbar degenerative disc disease and other lower back conditions as the cause of your pain, your doctor will likely perform the following 3 steps:
1. Assessment of patient history
Often the first step in diagnosing lumbar degenerative disc disease is an assessment of your recent medical history. As part of this assessment, your doctor will likely ask the following questions:
- When did your lower back pain begin?
- Any recent or remote trauma? History of cancer or metabolic and/or congenital disorders?
- Which activities and positions make your symptoms worse?
- Which treatments/medications have helped you find relief?
- How often do you experience symptoms? What is their severity?
The list above is not comprehensive, but it is helpful to write down your answers to these questions beforehand—as this can help you make the most out of the few minutes you get with your doctor.
2. Physical exam
After asking questions about your medical history, your doctor will then likely conduct a physical examination. This exam typically focuses on your lower back and legs (as this is the location of symptoms from lumbar degenerative disc disease).
The goal of this exam is to determine whether or not you exhibit signs of a symptomatic degenerative disc. To accomplish this goal, you doctor may test for any of the following:
- Range of motion
- Muscle strength
- Gait assessment
- Which motions provoke pain
- Muscle reflexes
- Curvature and alignment of your spine
- Local tenderness
To make the above tests easier, it is helpful if you wear athletic apparel to your appointment in order to facilitate movement.
3. Diagnostic imaging (X-rays, CT scans, & MRI scans)
X-rays are often the first step to understanding your spinal alignment and spinopelvic parameters (which indicate your natural posture). Fractures can also be diagnosed from x-rays, as well as instability and other disorders which may cause pain. X-rays are fast in providing physicians with baseline information regarding spinal disorders (such as degenerative disc disease), and they can make either CT scans or MRI scans more meaningful once obtained.
In some cases, your doctor may also order an MRI scan following your physical examination. This scan can help confirm a diagnosis of lumbar degenerative disc disease and rule out any other lower back conditions as contributing factors to your symptoms. An MRI scan is particularly useful in evaluation of the nerves of the lumbar spine, as well as the surrounding soft tissues (ligaments, discs, synovium, etc.).
An MRI scan can also help detect a collapsed disc space as well as cartilaginous endplate erosion. Both of these issues are closely linked with degenerative disc disease pain, and it will also show bulging discs and pinched nerves.
CT scans are rotational X-rays which provide the physician with a great deal of three-dimensional detail regarding bone anatomy, which is especially helpful in evaluating degenerative disorders (such as degenerative disc disease) of the lumbar spine. It is not uncommon for patients to require a CT scan for further illumination of anatomic findings not obvious from an X-ray or MRI.
However, it is important to note that a degenerated disc does not always cause pain. This means diagnostic imaging may display evidence of disc degeneration, but your lower back pain may actually be the result of a different condition (such as isthmic spondylolisthesis).
If you suspect you have lumbar degenerative disc disease, the first step to finding relief is to schedule an appointment with your doctor. She or he can help you find both the right diagnosis and the correct course of treatment.