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Endoscopically determined pain sources in the lumbar spine 

Endoscopically determined pain sources in the lumbar spine
Chapter:
Endoscopically determined pain sources in the lumbar spine
Author(s):

Martin T.N. Knight

DOI:
10.1093/med/9780199674107.003.0026
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date: 20 September 2020

Aware-state spinal endoscopy has allowed us to develop a patient-sensitive system for precisely identifying the sources of a patient’s pain and concepts that often confound conventional precepts of the generation of back, neck, and referred pain. Transforaminal endoscopy allows us to examine and palpate the exiting nerve, foraminal, and epidural contents under direct vision, at several levels, and match these findings to the patient’s predominant presenting symptoms (PPS). Patient feedback has taught us that the disc, epidural, foraminal, and extraforaminal structures, once irritated or inflamed, provide axial and referred pain. The mechanisms of pain production centre upon repetitive traction, impaction, or distortion of the tethered nerve more often than from the disc. These discrete pain sources are associated with persistent and disabling pain. The resolution of symptoms by their specific treatment or ablation confirms the significance of such sources.

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