Functional Anatomy and Pathophysiology of Axial Low Back Pain: Disc, Posterior Elements, Sacroiliac Joint, and Associated Pain Generators - 05/08/11

Doi : 10.1016/j.pmr.2010.07.005

Ariana J. Vora, MD ^a,^b,^c,^⁎ , Katherine D. Doerr, MD ^a,^c, Lee R. Wolfer, MD, MS ^d
^a Department of Physical Medicine and Rehabilitation, Harvard Medical School, 55 Fruit Street, Boston, MA 02144, USA
^b Massachusetts General Hospital Physical Medicine and Rehabilitation, 5 Longfellow Place, Suite 201, Boston, MA 02144, USA
^c Spaulding Rehabilitation Hospital, 125 Nashua Street, Boston, MA 02144, USA
^d Spinal Diagnostics and Treatment Center, 901 Campus Drive, Suite 312, Daly City, CA 94015, USA

Corresponding author. Department of Physical Medicine and Rehabilitation, Harvard Medical School, Massachusetts General Hospital, 5 Longfellow Place, Suite 201, Boston, MA 02144.

Résumé

Careful consideration of functional lumbosacral anatomy reveals the capacity for pain generation in the disc, zygapophysial joint, sacroiliac joint, and surrounding ligaments. However, the methods used to definitively implicate a particular anatomic structure in axial low back pain have limitations. Anatomically and biomechanically, the discs and posterior elements are inextricably connected to a dynamic biotensegrity network of ligaments, muscles, and fascia. This article examines key lumbosacral anatomic structures and their functional interdependence at the macroscopic, microscopic, and biomechanical level. Particular attention is given to the capacity of each structure to generate low back pain.

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Keywords : Low back pain, Tensegrity, Ligament, Fascia, Anatomy, Disc, Zygapophysial joint