38 Mechanical disorders of the lumbar spine Differential diagnosis 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 Only gold members can continue reading. Log In or Register to continue Share this:Click to share on Twitter (Opens in new window)Click to share on Facebook (Opens in new window) Related Related posts: Summary of hip pain Ankylosing spondylitis of the thorax pain of the thoracic cage and abdomen Connective tissue Disorders of the contractile structures Stay updated, free articles. Join our Telegram channel Join Tags: A System of Orthopaedic Medicine Jun 5, 2016 | Posted by admin in ORTHOPEDIC | Comments Off on Mechanical disorders of the lumbar spine: Differential diagnosis Full access? Get Clinical Tree Get Clinical Tree app for offline access Get Clinical Tree app for offline access
38 Mechanical disorders of the lumbar spine Differential diagnosis 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 Only gold members can continue reading. Log In or Register to continue Share this:Click to share on Twitter (Opens in new window)Click to share on Facebook (Opens in new window) Related Related posts: Summary of hip pain Ankylosing spondylitis of the thorax pain of the thoracic cage and abdomen Connective tissue Disorders of the contractile structures Stay updated, free articles. Join our Telegram channel Join Tags: A System of Orthopaedic Medicine Jun 5, 2016 | Posted by admin in ORTHOPEDIC | Comments Off on Mechanical disorders of the lumbar spine: Differential diagnosis Full access? Get Clinical Tree
