Glossary of Terms
Associated symptoms: It is essential to ask about urinary or bowel disturbance in any patient with back pain. Incontinence of urine or faeces suggests a cauda equina syndrome needing prompt investigation and treatment. Numbness, pins and needles and weakness of the foot should be elicited in the history and suggest true sciatica. Weight loss and a history of previous malignancy indicate possible malignancy.
Cauda equinasyndrome: In cauda equina syndrome there is bladder and bowel dysfunction with possible urinary retention and saddle anaesthesia. Bilateral leg symptoms are suggestive of impending cauda equina syndrome. In cauda equina syndrome there is loss of anal tone and reduced perineal sensation.
Conservative management: Non-surgical treatments such as drug therapy and physiotherapy.
Degenerative disc disease: Degenerative disc disease occurs with ageing and is related to decreased water content in the nucleus pulposis. The disc space narrows and the segment is said to become more mobile. It is this abnormal movement, together with an inability to distribute load that causes pain.
Discectomy: Removal of the soft part of the disc that is out of place.
Discitis/vertebral osteomyelitis: Discitis is infection of the disc space, and vertebral osteomyelitis infection of a vertebral body. The two often go hand in hand.
Disc prolapse: A slipped disc, also called a prolapsed or herniated disc, occurs when one of the discs of the spine is ruptured (splits) and the gel inside leaks out. This causes back pain and can also cause pain in other areas of the body. The majority of acute disc prolapses settle spontaneously with conservative treatment.
Epiduralinjections: Spinal nerves are blocked in the epidural space of the spine with the injection of local anaesthetic. Injections can provide short term relief from back pain.
Facet joint osteoarthritis: Pain from facet joint osteoarthritis of the spine can also radiate into the leg but the pain does not extend beyond the knee and is aching in character. Facet joint arthritis shows the typical features of osteoarthritis with joint space destruction and osteophyte formation. Occasionally facet joint injections for localised disease can relieve symptoms.
Fusion surgery: Fusing adjacent vertebrae in the spine.
Lumbar Spine: A term used to denote the region of the spine in the lower back area.
Magnetic resonance imaging: Magnetic resonance imaging is useful for looking at soft tissue structures, including identification of disc prolapse and causes of nerve root pain prior to surgery; and early detection of malignancy and infection.
Mechanical pain: The pain is worse on movement and activity.
Neurological deficit: Concerned with the examination of patients’ nerves, sensor and motor functions and reflexes.
Pathways: Pathways outline the appropriate patient journey based on best available evidence and expert clinical opinion. Lower back pain pathways are available for the management of specific and non-specific back pain as well as nerve root pain. There is supporting text in the supplementary information. Red flag areas are explained.
Radicular pain: Pain “radiated” along the dermatome, sensory distribution of a nerve due to inflammation or other irritation of the nerve root at its connection to the spinal column.
Red flags: Red flags are uses to indicate subspecialist assessment for emergency managementwhere serious spinal pathologyis suspected. This includes symptoms suggestive of cauda equina syndrome – bowel or bladder disturbance, saddle anaesthesia or for the emergency assessment of infection.
Sciatica: Sciatica is pain radiating into the leg as a result of lumbar nerve root compression.
Scoliosis: Scoliosis is an abnormal curvature of the spine to one side, with the spine bending either to the left or to the right. The amount of curvature can vary from slight to severe and the curve can be in the shape of a C or S.
Spinal Stenosis: Spinal stenosis is the narrowing of the central spinal canal or side root canals of the spine. This narrowing causes pressure on the nerve roots, leading to pain, usually in the lower back and legs. It is usually secondary to degenerative changes.
Spondylolisthesis: The slipping of one vertebral body on another. Persistent pain, radiculopathy and significant deformity are indications for considering surgery. Fusion with metal work and bone graft can be performed. The outcome is variable depending on the type and degree of slip.
Spondylosis: A term which covers disc degeneration and joint degeneration in the back. Osteoarthritis isusually implicated.
Spondylolysis: A spondylolysis is a defect in the pars interarticularis, which may allow the vertebra to slip forward causing a spondylolsthesis (forward slippage of one vertebra on another).
Yellow Flags: Psychosocial indicators used to assess the risks of progression to long-term distress, disability and pain. Yellow flags can relate to the patient’s attitudes and beliefs, emotions, behaviours, family, and workplace.