Diseases, Disorders information

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The diagnosis is frequently made, particular with things like MR, CT myelography, imaging modalities very clear again because of technological advances. The rest is the main stay of treatment, go to bed for six weeks, that kind of thing which was in text books until fairly recently, that surgical indications are very clear and the prognosis is poor. Well, actually, this last part may be a little bit truer than we would like to believe, but with the exception of that, as I mentioned a moment ago, all these things are false, and in fact, as you know from treating this in your own practices, that you seldom make the diagnosis of low back pain. There are a number of diagnostic codes that can be used for low back pain, most of which have very little clinical or anatomic significance, and the problem with that is that back pain is a symptom, it’s not a disease; so what does cause it? If we go back to the medical model where we actually want to make a diagnosis and then create a disease specific treatment plan, how can we do that with back pain, more on that in just a little bit.
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Part of the problem for low back pain, is the etiology is not clear, and the primary cause as identified by an expert, usually to be something within that expert’s realm of interest or clinical specialty.
If you talk to most surgeons, it’s a disc, ever since Mixter and Bard described disc herniations in 1934. If you talk to physiotherapists, it’s fascia and if you talk to just about any body else, it’s psychological, and that of course, is a real danger. There is a problem when you are dealing with a disease, you are giving a patient good care and they are not getting better, it’s easy to sit back and say the patient has psychological problems, what it really means is we haven’t approached it in a very intelligent manner. Well, the anatomy, and I promise this will be mercifully brief or your postprandial somnolence will take over, the slide on the right is from Frank Netter, the things I would like you to keep in mind from this, are the supporting structures of the spinal column.