Symptoms usually begin within 24 h after heavy lifting. Localized tenderness and muscle spasm over a particular area are significant and suggest a process in the back rather than in the pelvis or retroperitoneal area. CT or MRI is valuable in outlining axial spatial deformations and can evaluate processes in the viscera or retroperitoneal areas. Chronic arthritis of the posterior facet joints is usually associated with degenerative disk disease. The former is characterized by the usual clinical and radiologic findings in osteoarthritis, and the latter by associated nerve root irritation findings.
Hyperextension usually aggravates pain derived from posterior facet joints.
Intrapelvic and retroperitoneal conditions may be suggested by the presence of associated symptoms and by the absence of localizing signs in the back. Tumors and infections are more difficult to diagnose and may mimic a ruptured disk. A space-occupying tumor is frequently diagnosed by radionuclide scintiscan, CT, MRI, or myelography. CSF examination does not always differentiate ruptured disk from tumor because spinal fluid protein may be elevated in both conditions. CSF examination is indispensable in the diagnosis of spinal meningitis and other intradural infections.