A retrospective review of 1293 cases of
low back pain treated over a 12-year period revealed that sacroiliac joint syndrome and posterior joint syndromes were the most common
referred-pain syndromes, whereas herniated nucleus pulposus and lateral
spinal stenosis were the most common
nerve root compression lesions.
Referred pain syndromes occur nearly twice as often and frequently mimic the clinical presentation of
nerve root compression syndromes. Combined lesions occurred in 33.5% of cases. Lateral
spinal stenosis and herniated nucleus pulposus coexisted in 17.7%. In 30% of the cases of
spondylolisthesis, the radiographic findings were incidental and the source of
pain was the sacroiliac joint. Distinguishing radicular from
referred pain, recognition of coexisting lesions, and correlation of diagnostic imaging with the overall clinical presentation facilities formulation of a rational plan of
therapy. The above-outlined approach to managing
low back pain evolved over a 12-year period. Designed to establish a specific diagnosis, it should yield excellent or good results in 84% of patients.