الفهرس 
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Abstract
Introduction: LDP remain among the most common diagnoses encountered in clinical spine practice. The reported lifetime occurrence ranges from 40% to 50%. The highest prevalence is among people aged 30-50 years. LDP is a leading cause of job-related disability as it can produce severe, function-limiting pain because it can result in serious disability and progressive neurologic dysfunction. Pathophysiologic and biomechanical changes that occur due to degeneration of IVD strongly predispose to LDP. These changes are the result of the increase in age and other factors. The NP in a degenerated disc may prolapse and push out the weakened annulus. This usually occurs in a posterolateral direction. Disc herniation can be asymptomatic, but also can be a source of significant pain. Disk herniation can irritate adjacent nerve roots and is a leading cause of radiculopathy. In general, the more caudal nerve root is impinged by the herniated disc; that is, the L5 nerve root is impinged by an L4–5 herniation, and the S1 nerve root by an L5–S1 herniation. Neurologic evaluation of the lower extremities including motor testing, reflex testing, and tests for dermatomal sensory loss help to identify the specific nerve root involved. Early imaging studies are required in the small proportion of patients who have evidence of a significant or progressive neurologic deficit and those in whom an underlying serious condition ”red flag” is suspected as the cause of LBP. However, the great majority of patients with LBP do not need early imaging. The careful selection of patients for imaging studies avoids unnecessary testing. A major problem with all imaging modalities is that many of the anatomic abnormalities identified are commonly seen in asymptomatic individuals. Also, many age-related degenerative changes, may have no relationship to the patient’s chief complaint. The lack of the association between the patient’s symptoms and the radiologic findings remain a major challenge that faces the physician. Electrodiagnostic testing for persons suspected of having radiculopathies provides valuable information. The needle EMG examination is the most useful electrodiagnostic test but is limited in sensitivity. Electromyographic screening examinations using six muscles optimize radiculopathy identification yet minimize patient discomfort. Ninety percent of patients with disc herniation recover spontaneously within 4 weeks. Currently accepted indications for non-operative treatment of LDP include the absence of a progressive neurological deficit or CES. Thus, non-operative treatment is the initial pathway for the majority of patients with lumbar radiculopathy due to disc prolapse.
Conclusions: With aging, degenerative changes occur in the intervertebral disc and may lead to disc herniation. These are the most important causes of mechanical low back pain. Careful history taking and medical examination helps differentiate mechanical causes of low back pain from more serious (red flags) etiologies. Complete neurologic evaluation of the lower extremities in a patient with sciatica can identify the specific nerve root involved. Common degenerative findings seen on magnetic resonance imaging may be unrelated to symptoms. Electromyographic screening examinations using six muscles optimize radiculopathy identification yet minimize patient discomfort.