Mechanical disorders of the lumbar spine: Differential diagnosis

Published on 10/03/2015 by admin

Filed under Orthopaedics

Last modified 22/04/2025

Print this page

This article have been viewed 1547 times

[level-membership-for-orthopaedics-category]38

Mechanical disorders of the lumbar spine

Differential diagnosis

Therefore there is a need for a classification of spinal disorders based on simple clinical criteria. With the information gained from the history and examination, clinical syndromes can be defined and used as a basis for a classification which also embraces the concepts that have been described.

Syndromes

Lumbago (Box 38.1)

Box 38.1 Lumbago

Definition

• A sudden attack of severe and incapacitating backache

Mechanism

• Always caused by disc displacement, and thus comes entirely under the dural concept

• A large posterior shift of disc material compresses the dura mater: mechanism is dual; there is a discodural interaction

Symptoms

• Slow onset if the displacement is nuclear: nuclear lumbago

• Sudden onset if the shift is annular: annular lumbago

• Articular: twinges; severe pain during particular positions and movements, especially pain on sitting and on bending

• Dural: extrasegmental pain; pain on coughing and sneezing

Signs

• Articular: deviation; gross partial articular pattern

• Dural: painful neck flexion; limited straight leg raising

Natural history

• Spontaneous cure within 2 weeks in most cases

Treatment

• Hyperacute lumbago: epidural

• Annular lumbago: manipulation

• Nuclear lumbago: bed rest in psoas position; mobilizations–McKenzie techniques; no traction in the presence of ‘twinges’ or deviation

Backache (Box 38.2)

Box 38.2 Backache

Definition

• Pain in the lumbar area, with or without radiation in a dural diffuse manner; in most cases pain does not radiate beyond the gluteal folds

• Pain can be acute or chronic, intermittent or constant

Mechanism

• Acute and recurrent backache: almost always caused by a discodural interaction, thus symptoms and signs are very similar to acute lumbago, although milder. Dural symptoms and signs are sometimes subtle or even absent. A clear non-capsular pattern or a painful arc during flexion is pathognomonic for a small central disc protrusion

• Chronic backache: caused by either a discodural interaction or a lesion of a posterior structure (facet or ligament)

• Differential diagnosis depends on the clinical picture

Symptoms

Signs

Natural history

• Unpredictable: backache may recover spontaneously, but often does not. Chronic backache in particular shows no tendency to spontaneous cure

Treatment

Sciatica (Box 38.3).

Concepts (Fig. 38.1)

Fig 38.1 The three clinical lumbar concepts in relation to the natural ageing of anterior and posterior walls of the vertebral column.

Dural

Ligamentous

Stenotic.

Both syndromes and concepts have to be considered in the context of the normal changes in the ageing lumbar spine.

[/level-membership-for-orthopaedics-category][not-level-membership-for-orthopaedics-category]38

Mechanical disorders of the lumbar spine

Differential diagnosis

Syndromes

Lumbago (Box 38.1)

Box 38.1 Lumbago

Definition

• A sudden attack of severe and incapacitating backache

Mechanism

• Always caused by disc displacement, and thus comes entirely under the dural concept

• A large posterior shift of disc material compresses the dura mater: mechanism is dual; there is a discodural interaction

Symptoms

• Slow onset if the displacement is nuclear: nuclear lumbago

• Sudden onset if the shift is annular: annular lumbago

• Articular: twinges; severe pain during particular positions and movements, especially pain on sitting and on bending

• Dural: extrasegmental pain; pain on coughing and sneezing

Signs

• Articular: deviation; gross partial articular pattern

• Dural: painful neck flexion; limited straight leg raising

Natural history

Buy Membership for Orthopaedics Category to continue reading. Learn more here

[/not-level-membership-for-orthopaedics-category]

A System of Orthopaedic Medicine

Recent Posts

Categories

Search Engine

Mechanical disorders of the lumbar spine: Differential diagnosis

Mechanical disorders of the lumbar spine

Differential diagnosis

Mechanical disorders of the lumbar spine

Differential diagnosis