Turyn’s Sign Lumbar Disc Disease Classification

Turyn’s Sign

Lumbar Disc Disease Classification

Variation of the lumbar disc disease classification model is as follows:

1.      Disc protrusion:

a.      Type I: Peripheral annular bulge

b.      Type II: Localized annular bulge

2.      Disc herniation:

a.      Type I: Prolapsed intervertebral disc

b.      Type II: Extruded intervertebral disc

c.      Type III: Sequestered intervertebral disc

Categories of Low Back Pain

The following are five categories of low back pain:

1.      Viscerogenic pain: Pain that originates from the kidneys, sacroiliac, pelvic lesions, and retroperitoneal tumors. This type of pain is neither aggravated by activity nor relieved by rest.

2.      Neurogenic pain: Pain commonly caused by neurofibromas, cysts, and tumors of the nerve roots in the lumbar spine.

3.      Vascular pain: Pain characterized by intermittent claudication from aneurysms and peripheral vascular disease.

4.      Spondylogenic pain: Pain directly related to the pain originating from soft tissues of the spine and sacroiliac joint.

5.      Psychogenic pain: Pain that is quite uncommon and ascribed to nonorganic causes.

Sciatica

The origin of sciatica includes the following:

1.      Prolapsed intervertebral disc pressure, infection, and traumatic sciatic neuritis, perineural fibrositis, infections and tumors of the spinal cord.

2.      Lumbosacral and sacroiliac sprain and strain, degenerating intervertebral discs, fibrositis, osteomyelitis, hip joint disease, and secondary carcinomatous deposits in bone.

3.      Nephrolithiasis, prostatic, renal, and anal disease.

4.      Toxic and metabolic disorders, conversion hysteria, and arterial insufficiency.

Procedure:

1.      When the patient is in the supine position with both lower limbs resting straight out on the table, dorsiflexion of the great tor elicits pain in the gluteal region.

2.      The sign is significant for sciatic radiculopathy.

Clinical Pearl

A straight-leg-raising test this is positive under 30 degrees reveals a large disc protrusion. The nerve root is stretched long before it would normally be. The straight-leg-raising test is most useful for identifying L5-S1 disc lesions because the pressures on the nerve root are highest at this level. During straight leg raising, L4-L5 is not as apt to give as much pain as L5-S1 because the pressure between the disc and the nerve root at L4-L5 is half that at L5-S1. Therefore the L5-S1 disc lesion gives more pain in the lower back and leg than does the L4-L5 disc lesion. No movement on the nerve root occurs until straight leg raising reaches 30 degrees. No movement on L4 occurs during a straight leg raising test. From this, the presence of Turyn’s sign indicates a large disc protrusion at the level of the L5-S1 nerve root.