Low Back Disorders A Medical Enigma

by Cailliet, Rene

• ISBN13: 9780781744485
• ISBN10: 0781744482
• Edition: 1st
• Format: Paperback
• Copyright: 2003-03-07
• Publisher: LWW

Summary

Written by an expert renowned for his lucid, well-illustrated explanations of complex pain syndromes, Low Back Disorders: A Medical Enigma provides a clear understanding of the mechanisms underlying functional impairment of the spine. Using 100 new original drawings, Dr. Cailliet demonstrates the functional anatomy and biomechanics of the spine and explains how impaired biomechanics cause symptoms. The book describes in detail the discogenic pathology that is the predominant factor in impairment and clarifies current concepts on the causes of spinal instability. Dr. Cailliet thoroughly reviews treatment options and their physiological basis and offers recommendations on nonsurgical treatment of low back symptoms.

Author Biography

Rene Cailliet, M.D.: Professor Emeritus University of Southern California Keck School of Medicine; Clinical Professor School of Medicine University of California at Los Angeles

Table of Contents

Preface	viii
Foreword	xi
The Current Concern with the Low Back	1	(24)
Diagnosis	1	(1)
Symptoms Related to the Low Back	2	(4)
Specific Tissue of the Low Back: Sites of Nociception	6	(2)
The Intervertebral Disc	6	(2)
Factors of Examination to Determine the Pathoanatomic Basis of Symptoms	8	(1)
Tissue Sites of Pain and Impairment	9	(1)
The Intervertebral Disc	9	(1)
Spinal Instability	10	(1)
Radicular Symptoms and Findings	11	(2)
Confirmatory Tests	13	(1)
Myogenic Low Back Pain	13	(1)
Tension Myositis Syndrome	14	(4)
Facet Etiology of Low Back Pain	18	(1)
Spinal Stenosis	18	(1)
Neurologic Determination of Nerve Root Involvement	18	(2)
Clinical Measurement of Muscle Function	20	(1)
Test of an Increase in Intrathecal Pressure	21	(1)
The Milgram Test	21	(1)
The Naffziger Test	21	(1)
The Valsalva Maneuver	22	(1)
The Kernig Test	22	(1)
Electromyography	22	(1)
Discography	22	(1)
Summary	22	(3)
The Vertebral Column	25	(33)
The Lumbosacral Spine	27	(2)
Components of the Ligamentous Spine	29	(1)
The Intervertebral Disc	29	(1)
Collagen Fibers	30	(1)
Posterior Spinal Elements	31	(2)
The Zygapophyseal Joints: The Facets	33	(2)
Ligaments in Spinal Function	35	(1)
Muscular System of the Low Back	35	(4)
The Static Spine	39	(1)
Stability of the Static Spine	40	(2)
The Kinetic Lumbar Spine and the Lumbar-Pelvic Rhythm	42	(4)
Preparatory Trunk Motions	46	(12)
Radiculopathy	51	(7)
The Intervertebral Disc	58	(13)
Collagenous Plates	61	(4)
Nuclear Material Causing Nociception	65	(1)
Clinical Manifestations of Disc Disease	66	(2)
Summary	68	(3)
The Role of the Facets in Low Back Pain	71	(10)
Facet Joint Innervation	74	(1)
Degenerative Facet Disease	75	(1)
Clinical Manifestations of Facet Disease	75	(6)
Muscular Control of the Low Back	81	(9)
Spasm	82	(3)
Myogenic Pain	85	(2)
Fatigue	87	(1)
Myalgia	87	(1)
Conclusion	88	(2)
Miscellaneous Abnormal Conditions of the Low Back	90	(14)
Spondylolysis and Spondylolisthesis	90	(1)
Types of Mechanical Listhesis	90	(2)
Symptoms of Spondylolisthesis	92	(2)
Treatment	92	(2)
Spinal Stenosis	94	(2)
Scoliosis	96	(1)
Piriformis Syndrome	97	(3)
Sacroiliac Disease	100	(1)
Treatment	100	(1)
Sacro-iliac Pathology Secondary to a Pelvic Fracture	101	(1)
Sacralization of a Transverse Process	101	(3)
Treatment Protocols for Low Back Disorders	104	(39)
Management of Acute Symptoms of Low Back Disorders	110	(1)
Addressing Acute Pain	111	(1)
Steroids and Nonsteroidal Medications	111	(1)
Epidural Steroids	111	(1)
Physical Modalities for Treatment of Low Back Pain	112	(3)
Bed Rest	112	(1)
Cryotherapy	113	(1)
Therapeutic Heat	113	(1)
Manipulation	114	(1)
Traction	114	(1)
Exercise in the Treatment of Low Back Disorders to Regain Spinal Stability	115	(8)
Recruitment of Muscles in Spinal Stability	115	(2)
Specific Exercise Protocols	117	(1)
Flexibility	117	(1)
Strengthening Exercises	118	(3)
Back School	121	(2)
Intermittent Rest Periods	123	(1)
Psychologic Aspects of Low Back Disorders	123	(5)
Conclusion	128	(6)
Biologic Treatment of Sciatica	134	(9)
Subject Index	143