Posterior Displacement of C5 Vertebra

Focal anterior displacement of the thoracic spinal cord on magnetic resonance imaging (MRI) is typically seen in patients with intradural arachnoid cysts or spinal cord herniation. Posterior intradural arachnoid cysts displace and compress the spinal cord by mass effect, whereas spinal cord herniation is a displacement of the spinal cord through a dural defect secondary to a traumatic, postoperative, or idiopathic etiology (rx). Spinal cord herniation has been reported with increasing frequency in recent years, and it is an important differential diagnosis to consider with suspected intradural arachnoid cysts (rx). Once a dural defect has occurred, cerebrospinal fluid (CSF) pulsation may push the cord through the defect, resulting in progressive myelopathy (rx, rx).

Causes Of Posterior Displacement of C5 Vertebra

A Posterior Displacement disc can be caused by many degenerative spinal conditions or an injury. Below are the most common causes of a collapsed disc.

• Aging – Just like every other degenerative spine condition, the natural process of aging is the most common cause for the development of a posterior displacement of the disc. Over time, the discs lose water content making them brittle and less flexible. They’re meant to absorb the shock, acting like cushions for the spine, but they tend to lose their elasticity over time which increases their overall vulnerability. When this happens, the natural wear and tear from day-to-day activities can make it vulnerable to tears and bulging. Eventually, this can lead to diminished height or collapsed disc conditions.
• Weight – Another cause for a posterior displacement of disc condition is overweight problems. Our spine is primarily responsible for the support of our upper body weight. A heavier weight can increase the axial load exposed on the spine. As they are already more susceptible to damage with time, overweight increases the likelihood for the disc to collapse or to flatten out. This causes it to lose its normal shape, which can lead to different symptoms.
• High Impact Sports – Although aging is the most common cause of a posterior displacement of disc condition, participating in high-impact sports can also expose the spine to forceful blows that could potentially lead to a  posterior displacement of disc condition. Certain sports can also increase the axial load placed on the spine such as the impact of high-impact sports or repetitive motions such as twisting and swinging.
• Spinal Arthritis – Also known as osteoarthritis, this degenerative condition of the spine is due to aging. Researchers are also learning that some may have a genetic predisposition to spinal arthritis. As the joint structure and function are worn away, the spinal discs, posterior displacement of the disc may collapse causing the facet joints to rub together.
• Degenerative Disc Disease – As spinal discs become weaker and lose water content, this can cause the disc to collapse and posterior displacement of the disc loses height, greatly decreasing the space between vertebra posterior displacement of the disc.
• Herniated Disc – When the interior portion of the spinal disc ruptures the outer portion of the disc, this can cause nerve pain and cause the disc to fully collapse, posterior displacement of the disc.
• Sudden Injury – A serious injury caused by an auto accident, sports injury, or another type of serious injury can immediately cause a disc to collapse where there were previously no symptoms.
• Piriformis syndrome – This develops when the piriformis muscle, a small muscle that lies deep in the buttocks, becomes tight or spasms, which can put pressure on and irritate the sciatic nerve & cause collapsed disc.
• Spinal stenosis  – This condition results from the narrowing of the spinal canal with pressure on the nerves. It may lead to posterior displacement of the disc.
• Spondylolisthesis – This is a slippage of one vertebra so that it is out of line with the one above it, narrowing the opening through which the nerve exits with posterior displacement of the disc.
• Cauda equina syndrome – A rare but serious condition that affects the nerves in the lower part of the spinal cord; it requires immediate medical attention. Cauda equina syndrome may permanently damage the nervous system and even lead to paralysis.
• Bony growths (osteophytes) – Osteophytes are bony lumps (bone spurs) that grow on the bones of the spine or around the joints. They often form next to joints affected by osteoarthritis, a condition that causes joints to become painful and stiff.

• Bone spurs – are bony outgrowths on the edges of joints. Bone spurs form where cartilage is worn away (for example in arthritis) and bone is rubbing on bone. In an effort to protect the body, new bone forms on the edge of joints. This is called a bone spur, posterior displacement of the disc. Bone spurs are not painful in themselves, but unfortunately, the bone spurs can rub on nearby bones or nerves, causing problems. In the spine, bone spurs can intrude into space normally reserved for the nerves, thus causing sciatica.
• Sudden injury or accident – Some unexpected traumatic events, such as a car accident, can lead to sciatica. Injuries sustained and new scar tissue can place stress on the sciatic nerve, with posterior displacement of the disc.
• Pregnancy – During pregnancy, pain in the back of the thighs spurred by shifts in the pelvic region can be misdiagnosed as sciatica. However, there are situations in which the sciatic nerve is actually being pressed as a result of these changes. Speak to your doctor if you think you are suffering from sciatica or pelvic groin pain.
• Tumors – within the spine may compress the root of the sciatic nerve.

Symptoms of Posterior Displacement of C5 Vertebra

The following symptoms of a posterior displacement

Diagnosis Of Posterior Displacement of C5 Vertebra

History

Your doctor may ask about medical history in which you answer questions about your health, symptoms, and activity. Previous disease condition, fracture, lifestyle, geographical location, food habit, and acute and chronic disease, drug addictions, occupation of the patient for posterior displacement. In the lumbar spine, a herniated disc, and posterior displacement can present with symptoms including sensory and motor abnormalities limited to a specific myotome. History in these patients should include chief complaints, the onset of symptoms, where the pain starts and radiates. History should include if there is any past treatment history.

Pain history for the collapsed disc is-

• Duration – How long the pain is present?
• Onset – How did it start?
• Progress – What happened afterward?
• Site – Where do you feel the pain, point it out with a single finger?
• Character – What is the nature of pain? Is it throbbing, pricking, or burning type of pain?
• The intensity of pain – What is the severity of pain at present, at rest, and during activity? How severe was the worst pain you experienced?
• Temporal factors – Continuous or intermittent, diurnal variation.
  • Is the pain continuous or intermittent?
  • If intermittent, how long does each episode last?
  • If intermittent, is it colicky in nature?
  • Is there any relation between the severity of pain and the time of day?
  • Is there any sleep disturbance due to pain?
• Aggravating factors.
  • Is it aggravated by activity? Suggestive of mechanical pain.
  • Is it aggravated when getting up in the morning? If yes, how long does the increased pain last? Morning stiffness is present if the pain lasts for more than one hour. Morning stiffness is suggestive of inflammatory spondyloarthropathy.
  • Is it aggravated by walking? Suggestive of vascular or neurogenic claudication.
  • Is it aggravated by standing? Suggestive of neurogenic claudication.
• Relieving factors.
  • Is it relieved by activity? Suggestive of inflammatory spondyloarthropathy.
  • Is it relieved by rest? Suggestive of mechanical pain.
  • If aggravated by walking, is it relieved by standing? Suggestive of vascular claudication.
  • If aggravated by standing and walking, is it relieved by sitting down or stooping forwards? Suggestive of neurogenic claudication.
• Manual palpation Test
  • Palpation was conducted on the left side-lying position with pressure applied only to the onset of pain (P1).
  • The presence of generalized hyperalgesia made it difficult to establish a comparable finding day.

Physical exam

A physical exam to assess your strength – reflexes, sensation, stability, alignment, and motion.

A careful neurological examination can help in localizing the level of the compression. Sensory loss, weakness, pain location, and reflex loss are associated with posterior displacement.

• L1 Nerve – pain and sensory loss are common in the inguinal region. Hip flexion weakness is rare, and no stretch reflex is affected.
• L2-L3-L4 Nerves  – back pain radiating into the anterior thigh and medial lower leg; sensory loss to the anterior thigh and sometimes medial lower leg; hip flexion and adduction weakness, knee extension weakness; decreased patellar reflex.
• L5 Nerve – back, radiating into buttock, lateral thigh, lateral calf and dorsum foot, great toe; sensory loss on the lateral calf, dorsum of the foot, webspace between first and second toe; weakness on hip abduction, knee flexion, foot dorsiflexion, toe extension and flexion, foot inversion and eversion; decreased semitendinosus/semimembranosus reflex.
• S1 Nerve – back, radiating into buttock, lateral or posterior thigh, posterior calf, lateral or plantar foot; sensory loss on the posterior calf, lateral or plantar aspect of foot;  weakness on hip extension, knee flexion, plantar flexion of the foot; Achilles tendon; Medial buttock, perineal, and perianal region; weakness may be minimal, with urinary and fecal incontinence as well as sexual dysfunction.
• S2-S4 Nerves – sacral or buttock pain radiating into the posterior aspect of the leg or the perineum; sensory deficit on the medial buttock, perineal, and perianal region; absent bulbocavernosus, anal wink reflex.
• Motor exam
• Ankle dorsiflexion (L4 or L5)
• Test by having the patient walk on heels
• EHL weakness (L5)
• Manual testing
• Hip abduction weakness (L5)
• Have the patient lie on the side on the exam table and abduct leg against resistance
• Ankle plantarflexion (S1)
• Have the patient do 10 single leg toes stand

Manual Test For collapsed disc

Straight Leg Raise ( SLR) 

The Straight Leg Raise (SLR) test is a neurodynamic test. SLR is a neural tension test that can be used to rule in or out neural tissue involvement as a result of a space-occupying lesion, often a lumbar disc herniation collapsed disc. It is one of the most common neurological tests of the lower limb.

• A tension sign for L5 and S1 nerve root
• Can be done sitting or supine
• Reproduces pain and paresthesia in the leg at 30-70 degrees hip flexion
• Sensitivity/specificity most important and predictive physical finding for identifying who is a good candidate for surgery.

Contralateral SLR

• Crossed straight leg raise is less sensitive but more specific. Radicular pain in the affected leg when the contralateral asymptomatic leg is similarly raised constitutes a positive crossed straight-leg raise (X-SLR) test.

League Sign

• SLR aggravated by forced ankle dorsiflexion. Lasegue sign or straight leg raising test (SLRT) is a neurodynamic exam to assess nerve root irritation, posterior displacement, collapsed disc in the lumbosacral area.[rx] It is an integral element to the neurological exam for patients presenting with low back pain with or without radicular pain. The other less commonly used name is the Lazarevic sign.

Kernig Test

• Pain reproduced with neck flexion, hip flexion, and leg extension. Kernig’s sign is a test used in physical examination to look for evidence of irritation of the meninges, collapsed disc. The test involves flexing the thighs at the hip, and the knees, at 90-degree angles, and assessing whether the subsequent extension of the knee is painful (leading to resistance), in which case it is deemed positive.

Naffziger Test

A maneuver used to identify compression of nerve roots, collapsed disc in the cervical spine, based on exacerbation of pain and paraesthesias of the hand and fingers, when the examiner exerts pressure on the scalenus anterior muscles in patients with scalenus anterior syndrome. (for nerve root compression) increase or aggravation of pain or sensory disturbance over the distribution of the involved nerve root upon manual compression of the jugular veins bilaterally confirms the presence of an extruded intervertebral disk or other mass.

• Pain reproduced by coughing, which is instigated by lying patient supine and applying pressure on the neck veins Milgram test
• Pain reproduced with straight leg elevation for 30 seconds in the supine position
• Gait analysis
• Trendelenburg gait due to gluteus medius weakness which is innervated by L5.

Quadrant Test

• Position of patient – Standing
• Position of examiner – Standing behind the patient
• Procedure – Keep one hand over the patient’s contralateral shoulder and apply axial pressure. Ask the patient to hyperextend, rotate and laterally flex to the contralateral side.
• Interpretation – Provocative pain is taken as a sign of lumbar instability.
• Use – Used if pain cannot be produced by forwarding flexion, lateral flexion etc.

Adams Forward Bending Test

• Position of patient – Standing with feet together, knee extended.
• Position of examiner – Standing behind the patient first then in front of the patient.
• Procedure – Rule out limb length discrepancy. Ask the patient to bend forwards at the waist till the back is in the horizontal plane. Palms should be held together.
• Interpretation – If there is a rib or loin hump present, then there is structural scoliosis with rotation.
• Use – To differentiate between structural and non-structural scoliosis.
• Validity of test –  For a patient with 40 structural scolioses, the test has a sensitivity of 0.83 and a specificity of 0.99.

Additional manual test for nerve root compression

• Crossed SLRT – AKA well-leg raising test or Fajersztajn sign. When the contralateral leg is lifted, the patient experiences pain on the affected side. [rx][rx]This test is more specific than ipsilateral SLRT. It becomes positive, usually in severe compression and centrally located prolapse. Fajersztajn believed that this sign is due to disc prolapse, in the axilla of the root.[rx]
• Reverse SLRT – AKA femoral stretch test. While the patient is in a prone position, the leg is lifted off the table with both hip and knee joints extended. Some authors may allow knee flexion. This maneuver may reproduce radicular pain in the case of upper lumbar radiculopathy, far lateral lumbar disc, or femoral neuropathy. The pain will present in the femoral nerve distribution on the side of the lesion.[rx]
• Ely’s test or Duncan-Ely test – is used to assess rectus femoris spasticity or tightness. The patient lies prone in a relaxed state. The therapist is standing next to the patient, at the side of the leg that will be tested. One hand should be on the lower back, the other holding the leg at the heel. Passively flex the knee in a rapid fashion. The heel should touch the buttocks. Test both sides for comparison. The test is positive when the heel cannot touch the buttocks, the hip of the tested side rises up from the table, the patient feels pain or tingling in the back or legs.
• Braggart test – AKA Sciatic stretch test or Flip test. While raising the leg, the foot is held in a dorsiflexed position so that the sciatic nerve is stretched more, thereby increasing the intensity of pain or making it possible to elicit the sign early.[rx][rx]
• Reverse flip test – While raising the leg, the foot is held in a plantar-flexed position; this will lessen the pain. But if the patient is complaining of an increase in pain, it can suggest malingering.[rx]
• Bowstring sign – Also known as the popliteal compression test or posterior tibial nerve stretch sign. The patient can be examined in sitting or in a supine position. The examiner flexes the knee and applies pressure on the popliteal fossa, evoking sciatica. Some examiners do it after SLRT by flexing the knee to relieve the buttock pain. The pain would be reproduced by a quick snap on the posterior tibial nerve in the popliteal fossa.[rx]
• The five repetitive sit-to-stand tests (5R-STS) – wherein a patient with the ability to perform the test in around 10 seconds does not rate as having a significant functional impairment.[rx]

Less Frequently Used Nerve Root Irritation Tests For collapsed disc

For the sake of completion, other tests and signs of nerve root tension or irritation are discussed succinctly below

• Sitting SLRT (Bechterew test) – the patient is made to sit at the edge of a table with both hip and knee flexed, then made to extend the knee joint or elevate the extended knee, which reproduces the radicular pain and . They may be able to extend each leg alone, but extending both together causes radicular pain.[rx]
• Distracted SLRT – the sitting SLRT is performed without the patient’s awareness. The patient is distracted as if the surgeon is examining the foot or pulsation, and slowly, the examiner extends the knee. If the patient is experiencing true radiculopathy, the same pain will be reproduced. Otherwise, we can assume that the patient may be malingering.
•  Lasègue’s sign, Lasègue test or Lazarević’s sign – is a test done during a physical examination to determine whether a patient with low back pain has an underlying nerve root sensitivity, often located at L5 (fifth lumbar spinal nerve). With the patient lying down on their back on an examination table or exam floor, the examiner lifts the patient’s leg while the knee is straight. A variation is to lift the leg while the patient is sitting.^[rx] However, this reduces the sensitivity of the test.^[rx] In order to make this test more specific, the ankle can be dorsiflexed and the cervical spine flexed. This increases the stretching of the nerve root and dura.
• Neri’s sign – while bending forward, the patient flexes the knee to avoid stretching the nerve.[rx]
• The buckling sign[rx] – the patient may flex the knee during SLRT to avoid sciatic nerve tension.
• Sicard sign – passive dorsiflexion of ipsilateral great toe just at the angle of SLRT will produce more pain.
• Kraus-Weber test – the patient may be able to do a sit-up with the knees flexed but not extended.
• Minor sign – the patient may rise from a seated position by supporting himself/herself on the unaffected side, bending forward, and placing one hand on the affected side of the back.
• Bonnet phenomenon – the pain may be more severe or elicited sooner if the test is carried out with the thigh and leg in a position of adduction and internal rotation.[rx]

Provocative Tests In A Spinal Examination And collapsed disc

• Shoulder Abduction (Relief) sign – Active abduction of symptomatic arm achieved by patient placing their ipsilateral hand on their head. A positive test results in relief (or reduction) of cervical radicular symptoms.
• Neck Distraction test – Active distractive force is applied by the examiner while grasping the patient’s head under the occiput and chin. A positive test results in relief (or reduction) of cervical radicular symptoms.
• L’hermitte’s sign – Examiner passively flexes patient’s cervical spine. A positive test result is an electric shock-like sensation down the spine or extremities.
• Hoffman’s sign – Passive snapping flexion of distal phalanx of patient’s middle finger. A positive test results in flexion-adduction of the ipsilateral thumb and index finger.
• Adson’s test – Patient is instructed to inspire with chin elevated, and head rotated to the affected side. A positive test results in obliteration of radial pulse.
• The Spurling test – is designed to reproduce symptoms by compression of the affected nerve root. The cervical extension is used to induce/reproduce posterior bulging of the intervertebral disk. Rotation of the head causes narrowing of the neuroforamina in the cervical spine. Finally, axial compression is applied to amplify these effects with the aim of exaggerating the preexisting nerve root compression.
• The prone instability test – The patient starts by standing on one end of the examination couch. While continuing to stand on the foot end of the couch, the patient lowers his / her torso onto the couch.  The patient can hold onto the couch’s sides for support. The examiner then palpates the lower lumbar spine to elicit tenderness. The patient then holds onto the couch and lifts his / her feet off the ground tensing the paraspinal muscles. Less pain and tenderness on repeat palpation of the lower lumbar spine, while the feet are off the floor, is considered positive. [rx]
• Prone Plank/Bridge – The patient is prone and elevates his / her entire body off the couch/mat on forearms and tips of toes. The body should be parallel to the couch/mat. With adequate muscle strength, men should maintain this position for 124 +/- 72s and Women for 83 +/- 63s.[rx]
• Supine Bridge – The patient is supine and flexes the hip and knee to keep the feet flat on the couch/mat. The arms are flexed to position the hands beside the ears. The lower part of the torso and pelvis is lifted off the couch/mat, to maintain the trunk and the thigh in a straight line. With adequate muscle strength, men should maintain this position for 188 +/- 45s and Women for 152 +/- 30s. [rx]

Clinical Tests For Instability For collapsed disc

• Aberrant movement on flexion-extension – The standard examination involves documenting the range of movement. The quantitative range of movement may not be as significant as the qualitative range of movement. The important feature of spinal instability is the aberrant motion that occurs when flexing and extending the spine. A catch, a painful arc, supporting the arms on the thighs, or a reversal of the lumbopelvic rhythm when standing from the flexed posture indicates instability.[rx]
• Passive lumbar extension test – The subject lies on the examination couch. The examiner passively lifts the lower limbs to a height of 30 cm from the coach while maintaining the knee in extension and applying gentle traction on the legs. A positive test is recorded if the patient complains of “pain in the lower back region” or complains of “heaviness in the lower back” or complains that, “the lower back is coming off.” These experiences should return to normal when the leg returned to the couch. The passive lumbar extension test has the highest combined sensitivity and specificity and may be comparable to radiological findings to identify lumbosacral structural instability.[rx]
• The prone instability test – The patient stands at the foot end of the examination couch. The patient then lowers his/her upper body to rest on the examination couch. The iliac crest should rest on the edge of the examination couch. The patient holds the sides of the examination couch for increased stability. In the first part of the test, the feet of the patient is resting on the ground. The examiner with the heel of his/her hand creates a small posterior to anterior trust at each segment of the lumbar spine. Pain, if experienced by the patient, is recorded. In the second part of the test, the patient is asked to lift the feet of the floor and steady himself /herself by holding onto the sides of the examination couch. The examiner again repeats the posterior to anterior trust with the heel of his/her hand at each lumbar segment. The test is positive if the pain created in the initial part of the test subsides when the extensor muscles of the spine are tensed by lifting the feet of the floor.[rx]

Clinical Tests For Endurance In collapsed disc

• Sorensen test – The legs of the patient are strapped onto a low platform, which is only 25 cms above the floor.  The upper end of the iliac crest is aligned to the edge of the table. The upper torso rests on the floor. At the commencement of the test, the patient extends the spine and lifts the upper torso off the floor with the arms crossed across the chest, and is asked to maintain the horizontal position. The record of the time, the patient can maintain this position is documented.  Normative values: Men 146 +/- 51. Women 189 +/- 60.[rx]
• Prone isometric chest raise – The patient lies prone on the examination couch with a pad underneath the abdomen and the arms along the sides. The patient is instructed to lift the upper trunk about 30 degrees from the table while keeping the neck flexed, and the intention is to hold the sternum of the surface of the couch. The clinician records the maximum time that the patient can hold this position. [rx]Normative values: Men 40 +/- 9. Women 52 +/- 18.[rx]
• Prone double straight leg raise – The patient lies prone on the examination couch with the hips extended and the hands underneath the forehead. The arms are perpendicular to the body. The patient is then requested to lift both the legs off the couch until the knee is cleared off the couch. The patient should maintain normal breathing during the entire test procedure. The examiner can monitor the knee clearance by sliding a hand under the knee. The clinician records the maximum time that the patient can hold this position. Normative values: Men 38 +/- 6. Women 35 +/- 5. The prone double straight leg raise has shown to have great sensitivity and specificity. [rx]
• Supine static chest raise – The patient lies supine on the couch with the legs extended. The hands are placed on the temples with the elbows pointing to the ceiling.  The patient is then instructed to lift the head, the arms and the upper trunk of the couch. The patient should maintain normal breathing during the entire test procedure. The clinician records the maximum time that the patient can hold this position. Normative values: Men 43 +/- 9. Women 32 +/- 5. [rx]
• Supine double straight leg raise – The patient lies supine with the legs extended, and the arms crossed in front of the chest. The pelvis is tilted forward to increase the lumbar lordosis. The patient is then requested to lift both the legs of the floor for 30 degrees while maintaining normal breathing during the entire test procedure. To monitor the pelvic tilt, the examiner can place one hand under the lumbar spine.  The clinician records the maximum time that the patient can hold this position. Normative values: Men 28 +/- 4. Women 28 +/- 4. [rx]
• Flexor endurance test – The patient is supine on the couch with the upper part of the body propped up on a support. The support is at an angle of 60 degrees. The legs are flexed so that the knee is at a 90-degree angle with the foot flat on the couch. The toes and feet are strapped to the couch to provide a counterbalance. In a modified procedure, the examiner sits on the edge of the couch and over the toes of the patient to provide a counterbalance. The arms are crossed across the chest towards the opposite shoulder. The support is moved back by 10 cms, and the patient is instructed to maintain the original position. The clinician records the maximum time that the patient can hold this position. Normal values: Men 144 +/- 76, Women 149 +/- 99 in normal subjects.[rx]
• Prone Plank/Bridge – The patient lies prone on a mat. Initially, the patient lifts his / her upper torso off the mat and steadies on the elbows and forearms. The elbow is directly below the shoulder, and the forearms are straight with hands in front of the elbow. The patient then lifts the pelvis off the mat. The body is now supported on the elbow/forearm and the tips of the toes. The patient maintains a rigid horizontal position parallel to the floor. The clinician records the maximum time that the patient can hold this position. Normative values: Men 124 +/- 72s, Women 83 +/- 63s.[rx]
• Supine Bridge – The patient lies supine with the legs flexed so that the knee is at a 90-degree angle, and the foot is flat on the couch but not touching each other. The elbows are bent, and the hands are placed on the ears. The patient then lifts the pelvis so that the shoulders, hips, and knees are in a straight line. A rigid position is maintained, and the clinician records the maximum time that the patient can hold this position. Normative values: Men 188 +/- 45s, Women 152 +/- 30s.[rx]
• Side Plank/Bridge – The patient lies on the side on a mat. The upper part of the body is lifted off the mat and supported on the elbow of the arm below. The opposite (upper) arm crosses across the chest onto the lower shoulder. The top foot is positioned in front of the lower foot. The patient is then instructed to lift the pelvis off the floor and to maintain the trunk and the legs in a straight line. A rigid position is maintained, and the clinician records the maximum time that the patient can hold this position. Normative values: Men 95 +/- 35s, Women 74 +/- 33s.[rx]

Waddell Signs For Collapsed disc Include

• Superficial tenderness – The patient’s skin over a wide area of the lumbar skin is tender to light touch or pinch.
• Non-anatomical tenderness – The patient experiences deep tenderness over a wide area that is not localized to one structure and crosses over non-anatomical boundaries.
• Axial loading – Downward pressure on the top of the patient’s head elicits lumbar pain.
• Acetabular rotation – Lumbar pain is elicited while the provider passively and simultaneously externally rotates the patient’s shoulder and pelvis together in the same plane as the patient stands. It is considered a positive test if pain occurs within the first 30 degrees of rotation.
• Distracted straight leg raises discrepancy – The patient complains of pain during a straight leg raise during formal testing, such as when supine, but does not on distraction when the examiner extends the knee with the patient in a seated position.
• Regional sensory disturbance –The patient experiences decreased sensation fitting a stocking-like distribution rather than a dermatomal pattern.
• Regional weakness – Weakness, cogwheeling, or the giving way of many muscle groups that are not explained on a neuroanatomical basis.
• Overreaction – A disproportionate and exaggerated painful response to a stimulus that is not reproduced when the same provocation is given later. These responses can include verbalization, facial expression, muscle tension, or tremor.[trx],[rx]

Lab Test For Diagnosis of 

A doctor can diagnose cauda’s low back pain or Collapsed Disc. Here’s what you may need to confirm a diagnosis

• Laboratory testing – may include white blood cell (WBC) count, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP).
• Elevated ESR – could indicate infection, malignancy, chronic disease, inflammation, trauma, or tissue ischemia.
• Elevated CRP – levels are associated with infection.
• RBS – To diagnosis, diabetes and it related health problem, burning sensation, etc
• Rheumatoid factor and anti-CCP – cyclic citrullinated peptide antibodies test should be increased if there is clinical abnormality for PLID, collapsed disc, or right and left side back pain are found.
• A serum uric acid level – It is often considered by clinicians and doctors when PLID, collapsed disc is suspected, but it is not a reliable and dangerous condition of your kidney as it may be spuriously elevated or high in acute inflammatory conditions or acutely during an attack or not.
• Serologic studies – There are no blood tests used to specifically support the diagnosis of nerve compression, collapsed disc, demyelination but the use of these tests may be necessary for medical conditions that can either increase nerve compression or can decrease their symptoms. Some of the most frequently find conditions include diabetes and hypothyroidism. The assessment of a patient’s fasting blood glucose, hemoglobin A1c, or thyroid function tests may be helpful in the general management of the patient. Other conditions that could mimic nerve compression include deficiency of vitamin B12 or folate, vasculitides, and fibromyalgia.
• Synovial fluid analysis – A joint arthrocentesis or the system of aspiration of synovial fluid with blood and synovial fluid analysis that are mandatory if an infection is suspected or dangerous. The fluid analysis or any kind of abnormalities is also helpful in diagnosing crystal formation with osteophyte and steroid-induced arthritis. The degree of the high elevation of synovial fluid are founded by WBC count can be useful in differentiating inflammatory abnormality or from non-inflammatory causes of right and left side neck pain.

Imaging Test For collapsed disc

• X-rays – can show the alignment of the bones and whether the patient has arthritis or broken bones. They are not ideal for detecting problems with muscles, the spinal cord, nerves, or disks, collapsed discs.
• Computed Tomography (CT) scan – is a noninvasive test that uses an X-ray beam and a computer to make 2-dimensional images of your spine. It may or may not be performed with a dye (contrast agent) injected into your bloodstream. This test is especially useful for confirming which bulging disc,  is damage and is good for revealing herniated disks or problems with tissue, tendons, nerves, ligaments, blood vessels, muscles, and bones.
• Bone scan – a bone scan may be used for detecting bone tumors or compression fractures caused by brittle bones (osteoporosis). The patient receives an injection of a tracer (a radioactive substance) into a vein. The tracer collects in the bones and helps the doctor detect bone problems with the aid of a special camera.
• Magnetic Resonance Imaging (MRI) scan – is a noninvasive test that uses a magnetic field and radiofrequency waves to give a detailed view of the soft tissues of your spine with a bulging disc, collapsed disc. Unlike an X-ray, nerves and discs are clearly visible. It may or may not be performed with a dye (contrast agent) injected into your bloodstream. An MRI can detect which disc is damaged and if there is any nerve compression. It can also detect bony overgrowth, spinal cord tumors, or abscesses.
• Nuclear Magnetic resonance imaging (MRI) scan – which uses magnetic fields and computers to produce three-dimensional images of your spine.
• A myelogram – is a specialized X-ray where dye is injected into the spinal canal through a spinal tap. An X-ray fluoroscope then records the images formed by the dye. The dye used in a myelogram shows up white on the X-ray, allowing the doctor to view the spinal cord and canal, PLID, a bulging disc in detail. Myelograms can show a nerve being pinched and a bulging disc by a herniated disc, bony overgrowth, spinal cord tumors, and abscesses.
• Electromyography (EMG) & Nerve Conduction Studies (NCS) – EMG tests measure the electrical activity of your muscles. Small needles are placed in your muscles, and the results are recorded on a special machine. NCS is similar, but it measures how well your nerves pass an electrical signal from one end of the nerve to another. These tests can detect nerve damage and muscle weakness and a bulging disc, collapsed disc, and PLID. [rx][rx]
• Discogram – A discogram may be recommended to confirm which bulging disc and PLID is painful if surgical treatment is considered. In this test, the radiographic dye is injected into the disc to recreate disc pain from the dye’s added pressure. It is useful for the evaluation of patients who are experiencing cervical discogenic pain or have multiple herniations in which surgery is a strong possibility. However, the diagnostic procedure remains controversial as it may accelerate the degeneration of normal discs.[rx]
• CT myelogram – CT is most useful when combined with the injection of intrathecal contrast (myelography) to better evaluate the location and amount of neural compression. It is more invasive than an MRI but can be a consideration in patients who have a contraindication to MRI (e.g., pacemaker) or have an artifact from the hardware.
• Cerebrospinal fluid analysis – is a useful test if there is a suspected neoplasm or infectious cause or radiculopathy symptoms. The recommendation for a lumbar puncture is in the case of a patient with negative or nondiagnostic neuroimaging, without known primary cancer, who has progressive neurological symptoms and has failed to improve promptly.[rx]
• Bone scintigraphy – with single-photon emission computed tomography (SPECT) is more sensitive in detecting facet joint lesions and allows more accurate anatomical localization. A recent study suggested that SPECT could help to identify patients with low back pain, PLID who would benefit from facet joint injections [rx].
• Foraminal nerve root entrapment test – is best visualized on T1-weighted MRI where the high contrast between fat tissue and the nerve root sheath is of great help. Usually, a combination of hypertrophic degenerative facets with osteophytes spurs posteriorly, and vertebral osteophytes and PLID/collapsed disc or disc herniation anteriorly diminish the anteroposterior diameter of the foramen. Foraminal height is lessened by degenerative disc disease and subsequent disc height loss. Whenever the normal rounded (oval) appearance of the nerve root sheath is lost in combination with loss of the surrounding fat tissue, nerve root compression should be considered.
• Urodynamic studies – may be required to monitor the recovery of bladder function following decompression surgery.
• Electrodiagnostic studies – Electromyography and nerve conduction test studies help to localize the nerve problem involved as well as where along the course of the nerve it is affected. Additionally, testing can serve as a baseline for comparison with the future during the course of treatment. It is important to note that normal electrodiagnostic studies do not identify disease, and clinical correlation should include the patient’s history and physical examination findings.[rx]

In most cases of low back pain, medical consensus advises not seeking an exact diagnosis but instead beginning to treat the pain. This assumes that there is no reason to expect that the person has an underlying problem. In most cases, the pain goes away naturally after a few weeks. Typically, people who do seek diagnosis through imaging are not likely to have a better outcome than those who wait for the condition to resolve.