Disc Herniation Associated to Other Conditions

The clinical presentation of central stenosis associated with marked annular bulging or disc herniation is extremely variable. In some cases, signs and symptoms differ from those typical of lumbar stenosis: chronic symptoms with a predominance of radicular disturbances with respect to low back pain; bilateral radicular symptoms, even if often predominant on one side; no symptoms at rest; sensory, astenic or, less commonly, painful intermittent claudication; and negative nerve-root tension tests. A clinical presentation typical of stenosis is usually observed when the disc condition is represented by slight annular bulging. In the presence of a herniated disc, signs and symptoms are more often those typical of disc herniation: recent onset or exacerbation of symptoms; predominance of radicular pain with respect to sensory and motor dysfunction; unilateral radicular symptoms; pain at rest; no or essentially painful intermittent claudication; and positive nerve-root tension tests. The latter, however, tend to be slightly positive, particularly in elderly patients, who are those most frequently presenting stenosis.