Internal Medicine

0521779407-10 CUNY1086/Karliner 0 521 77940 7 June 7, 2007 18:40

Intertrigo Intervertebral Disc Disease 847

higher-potency corticosteroids such as betamethasone diproprion-

ate or triamcinolone, as they frequently cause atrophy and striae.

follow-up

During Treatment

■Re-evaluate patient 1–2 weeks after initiating therapy.

complications and prognosis

n/a

Intervertebral Disc Disease.............................

MICHAEL J. AMINOFF, MD, DSc

history & physical

■Pain in neck or back

■Radicular pain

■Aggravation of pain by increased intraspinal pressure (eg, cough) or

stretch of compressed roots

■Weakness, numbness or paresthesias in a radicular distribution may

occur

■Sphincter or sexual disturbances may occur

■Spasm of paraspinal muscle & restriction of spinal movements

■Spinal tenderness may be present

■Weakness, sensory changes or both in radicular distribution some-

times found

■Reduced or absent tendon reflex subserved by affected root

■Pain reproduced by root stretch (eg, passive straight leg raising;

femoral stretch test)

■May be bilateral radicular deficits w/ central disc prolapse affecting

cauda equina or associated spinal stenosis

■May be signs of cord compression w/ central disc protrusion above

L1 level

tests

■MRI to define nature & extent of root compression & exclude other

causes of compression

■EMG to define extent & severity of root involvement & likely prog-

nosis