Endoscopically Determined Pain Sources in the Lumbar Spine

Abstract

Since 1990, we have used aware-state surgery to treat spinal disorders as part of the process of viviprudence. Viviprudence is the evaluation cascade of in-depth questionnaires, postural analysis, extended clinical examination and weight-bearing X-rays which underpin initial examination. This is followed by extended postural restabilisation and motor reprogramming physiotherapy for 6–12 weeks, after which persistent debilitating symptoms merit MRI scanning. This is followed by spinal probing and discography wherein spinal probing is the most valuable entity. Multiple-point probing serves to pinpoint pain sites at the facet margin, neural margins, annulus and in the safe working zone (SWZ). The safe working zone is a triangular region bounded by the dura or traversing nerve medially, the medial border of the exiting nerve laterally, and the superior end-plate margin of the inferior-bounding vertebra. Discography reproduces pain in only 27% of patients with non-compressive radiculopathy but is valuable in defining the disposition of degeneration within the disc and the integrity of the annulus.