- Part 1 Introduction to musculoskeletal medicine
- Part 2 Structural pathology; dysfunction; pain
- Part 3 Regional disorders
- Chapter 23 Clinical examination
- Chapter 24 Investigative techniques
- Chapter 25 Musculoskeletal injections
- Chapter 26 Endoscopically determined pain sources in the lumbar spine
- Chapter 27 Regional somatic dysfunction
- Chapter 28 Thoracic outlet syndrome
- Chapter 29 Chest wall pain
- Chapter 30 The joints of the shoulder girdle
- Chapter 31 Structural disorders of the shoulder
- Chapter 32 Rehabilitation strategies—shoulder disorders
- Chapter 33 Upper limb disorders
- Chapter 34 The pelvis
- Chapter 35 Sacroiliac joint disorders
- Chapter 36 Structural disorders of the knee
- Chapter 37 Patellofemoral/extensor mechanism disorders
- Chapter 38 Soft tissue injuries at the knee
- Chapter 39 Superior tibiofibular joint
- Chapter 40 Exertional lower leg pain
- Chapter 41 Biomechanics of the foot and ankle
- Chapter 42 The ankle joint
- Chapter 43 The subtalar joint
- Chapter 44 Plantar fasciitis and heel pain
- Chapter 45 Tendinopathies and enthesopathies
- Chapter 46 Metatarsalgia
- Chapter 47 Podiatry (podiatric medicine and surgery)
- Part 4 Management strategies
(p. 260) Endoscopically determined pain sources in the lumbar spine
- Chapter:
- (p. 260) Endoscopically determined pain sources in the lumbar spine
- Author(s):
Martin T.N. Knight
- DOI:
- 10.1093/med/9780199674107.003.0026
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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- Part 1 Introduction to musculoskeletal medicine
- Part 2 Structural pathology; dysfunction; pain
- Part 3 Regional disorders
- Chapter 23 Clinical examination
- Chapter 24 Investigative techniques
- Chapter 25 Musculoskeletal injections
- Chapter 26 Endoscopically determined pain sources in the lumbar spine
- Chapter 27 Regional somatic dysfunction
- Chapter 28 Thoracic outlet syndrome
- Chapter 29 Chest wall pain
- Chapter 30 The joints of the shoulder girdle
- Chapter 31 Structural disorders of the shoulder
- Chapter 32 Rehabilitation strategies—shoulder disorders
- Chapter 33 Upper limb disorders
- Chapter 34 The pelvis
- Chapter 35 Sacroiliac joint disorders
- Chapter 36 Structural disorders of the knee
- Chapter 37 Patellofemoral/extensor mechanism disorders
- Chapter 38 Soft tissue injuries at the knee
- Chapter 39 Superior tibiofibular joint
- Chapter 40 Exertional lower leg pain
- Chapter 41 Biomechanics of the foot and ankle
- Chapter 42 The ankle joint
- Chapter 43 The subtalar joint
- Chapter 44 Plantar fasciitis and heel pain
- Chapter 45 Tendinopathies and enthesopathies
- Chapter 46 Metatarsalgia
- Chapter 47 Podiatry (podiatric medicine and surgery)
- Part 4 Management strategies