Case history
Case history #1
A 48-year-old insurance salesman presents with a 25-year history of back pain. He developed severe back pain while stacking shelves at the local supermarket at age 23. The pain resolved after 10 days of bed rest followed by 3 months of physical therapy. He has had multiple episodes of back pain occurring at increasing regularity over the years and, in the past 10 years, has changed his occupation to salesperson. Currently, he has back pain measuring 8 out of 10 on a visual analog scale and bilateral leg pain. The back pain is exacerbated by flexion, and the leg pain is reproduced by a straight leg raise of 70 degrees. He has numbness of both feet in the L5 dermatome; motor and reflexes are normal.
Case history #2
A 68-year-old man presents with increasing back pain. The pain started when he was in his 30s, and has progressed over time. He now also reports heaviness in both his legs when he walks 2 blocks. He retired from his job as a teacher 3 years ago, and now spends a large proportion of his time gardening. He can sit for only few minutes, and then has great difficulty in getting up. He has no other medical conditions. On examination, his spinal range of motion is very disturbed. He stands with a forward stoop. He can stand on his toes and heels and has a normal neurological examination. A straight leg raise causes no pain or restriction.
Other presentations
Progression of disk degeneration may lead to additional painful manifestations, including loss of disk height and facet joint arthrosis, disk herniation and nerve root irritation, and hypertrophic changes resulting in spinal stenosis.[1][2] As a result, patients with degenerative disk disease may present with a variety of symptoms that range from mild localized tenderness to severe excruciating radicular pain and lower extremity symptoms.
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