Renewed Considerations in the Diagnosis and Treatment of Degenerative Zygapophyseal lpar;Facetrpar; Jointcomma; Primary Discogeniccomma; and Intrinsic Nerve Root Pain Syndromes of the Lower Back and Extremities

摘要

This article provides a review of a category of degenerative lower back pain syndromes associated often with atypically referred lower extremity pain. These syndromes are not derived from the more commonly considered anatomic and, hence, surgical lesions of the lumbosacral spinal units, such as frank disc herniation, canal or foraminal stenosis, or dynamic instability within the lumbosacral region. All these lesions are associated with compression of nerve root(s) or distal cord, as usually indicated by distinct clinical and radiographic presentations, and are relieved by a variety of surgically decompressive and/or fusion techniques. However, in this article an overview will be presented, and the history, anatomy, diagnosis, and treatment of less typical, often less-considered, pain syndromes will be discussed. These syndromes are derived from other potential loci within the functional spinal unit(s) and require a different approach, and even mind-set, of assessment, localization, diagnosis, and management.