These structures are closely related, and disease or deformity of one often affects the other. Lumbar disc lesions usually cuase root syndromes. Pathology Disc protrusions usually occur posterolaterally, because here the annulus fibrosus is no longer reinforced by the posterior longitudinal ligament. Occasionally, pain is produced when there is a tear in the annulus but no protrusion. Disc lesions heal by fibrosis but there is always a risk of recurrence.
Degenerative changes are present in the intervertebral discs of all subjects by middle-age.
These are more marked, and occur earlier, after disc prolapse. Back pain also occurs when bone is affected by tumour, infection or metabolic disease. The patient experiences unremitting pain, which is worse at night and exacerbated by movement. Investigation Radiology Plain radiographs of the lumbar spine are of little diagnostic help. In contrast, marked degenerative and disc space changes can be present in the absence of any symptoms or can easily be falsely interpreted as the cause of symptoms.