Denne et al. Journal of Medical Case Reports 2011, 5:440 http://www.jmedicalcasereports.com/content/5/1/440 Chronic painful physical conditions can increase the severity and duration of a depressive mood [17]. Vice versa, it is well documented in the literature that psy- chological factors play a key role in the pain perception process and the chronification of back pain [18]. The resulting chronic muscular imbalance and pathological muscular hypertension may be the basis for disc protru- sion and disc rupture. Additionally, studies based on clinical [19] and experimental [20] data show that the risk for LDH is significantly increased in cases with a positive family history. Conclusions LDH can lead to a vicious cycle for patients with CF as it may promote pulmonary infections and may decrease life expectancy. This underlines the need to investigate patients correctly and operate if necessary. Consent Written informed consent was obtained from the patients and the patient’s next-of-kin for publication of this manuscript and any accompanying images. A copy of the written consent is available for review by the Edi- tor-in-Chief of this journal. Author details 1Department of Pediatrics, Kinderklinik München Schwabing, Klinikum Schwabing StKM GmbH and Klinikum Rechts der Isar (AöR) of the Technical University (TU) München, Munich, Germany. 2Department of Pediatric Radiology, Institute for Diagnostic Radiology, Klinikum Schwabing StKM GmbH, Munich, Germany. 3Department of Neurosurgery, Klinikum Schwabing StKM GmbH, Munich, Germany. Authors’ contributions CD wrote the article, and conceived of the study in cooperation with AV. HW gave psychological and MS radiological advice. MS was also involved in the diagnostic process as neurosurgeon. 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