The first steps for a lumbar DDD diagnosis include the following:
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- A medical history is collected that details current symptoms, including when the pain began, if pain is accompanied by other symptoms such as numbness or tingling, and if pain started after an injury. A medical history also gathers information on regular physical activity, sleep habits, and past injuries.
- A physical exam tests the spine’s range-of-motion and strength. A physical exam may include feeling by hand (called palpation) along the lower spine to locate areas of tenderness, inflammation, or physical abnormalities. Additionally, movement tests that determine which motions or positions alleviate or worsen pain can help indicate where pain is produced in the spine.
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See Preparing to See A Doctor for Back and Neck Pain
The above diagnostic methods are typically enough to diagnose pain from a spinal disc, and most cases can be diagnosed by visiting a primary care physician. Other cases may require insight from a spine specialist and/or additional testing. In order to locate the specific segment of disc degeneration, diagnostic imaging tests may be used.
See Specialists Who Treat Back Pain
Diagnostic Imaging for Degenerative Disc Disease
A definitive diagnosis for lumbar DDD may require an MRI scan to ensure that other issues are not contributing to pain, such as a fracture or disc herniation. If surgery is needed, an imaging test is required prior to the procedure to accurately locate the degenerated disc and plan the surgery.
See Diagnostic Processes for Neck and Back Pain
An MRI (magnetic resonance imaging) scan uses a high-powered magnet to align and detect water molecules in the body, which allows doctors to visualize soft tissues such as muscles, ligaments and tendons, and spinal discs. MRI scans rely on magnetism rather than radiation—used in x-ray and CT scans—so there is little risk involved in an MRI scan, and scans are not painful.
See MRI Scan of the Spine
MRI scans can provide useful information concerning:
- Disc height
- Disc shape
- Endplate erosion
- Pinched nerves
- Disc hydration (if there is little or no hydration, it may be referred to as a black disc, as the disc will appear black on the MRI scan)
See Do I Need an MRI Scan?
Bulging Disk X-ray
Studies have shown that MRI findings of mild or significant disc degeneration are found on scans of patients with severe pain and minimal or no pain. Additionally, many painful conditions may not show up on an MRI, such as a tear in the disc’s outer rings or some cases of herniated discs. For this reason, a diagnosis cannot rely solely on imaging tests and must be used in combination with a medical history and physical examination.
As you may know, the symptoms provoked by lumbar degenerative disc disease can mimic those caused by other lower back conditions.
See Lumbar Degenerative Disc Disease Symptoms
Continuous, low-grade pain is a common symptom of lumbar degenerative disc disease.
Read:Diagnosing Lumbar Degenerative Disc Disease
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:
See Causes of Pain in the Lumbar Spine
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.
See Specialists Who Treat Back Pain
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).
See Diagnosing 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
- Sensation
- Reflexes
- 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.
See Preparing to See A Doctor for Back and Neck Pain
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.
See X-Ray of the Spine
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.).
See MRI Scan of the Spine
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.
See What's a Herniated Disc, Pinched Nerve, Bulging Disc...?
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.
See Computerized Tomography (CT Scan)
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).
See Isthmic Spondylolisthesis Symptoms
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.
Degenerative Disk X Ray
See Getting an Accurate Back Pain Diagnosis
X Ray Risks
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