Published on 10/03/2015 by admin
Filed under Orthopaedics
Last modified 10/03/2015
This article have been viewed 1141 times
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Activity-related lumbar disorders have a multifactorial origin. Diagnostic precision is difficult, and imaging techniques usually have a relatively low specificity. Nevertheless, the clinician is required to make an accurate diagnosis, to choose an appropriate management strategy and to determine prognosis.
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
A System of Orthopaedic Medicine
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