Low Back Pain and Sciatica : A New Pathogenetic Model and Treatment Principles / by Luigi Tesio.

Format:

Book

Author/Creator:

Tesio, Luigi, Author.

Series:

Medicine Series

Language:

English

Subjects (All):

Physical therapy.

Orthopedics.

Nervous system--Surgery.

Nervous system.

Rheumatology.

Physiotherapy.

Orthopaedics.

Neurosurgery.

Local Subjects:

Physiotherapy.

Orthopaedics.

Neurosurgery.

Rheumatology.

Physical Description:

1 online resource (XIV, 113 p. 21 illus.)

Edition:

1st ed. 2025.

Place of Publication:

Cham : Springer Nature Switzerland : Imprint: Springer, 2025.

Summary:

Chronic benign “back pain “, with or without sciatica, is a descriptive diagnosis hiding the mechanisms leading to this symptom. The literature still refers to it as a “non-specific” disease. Not surprisingly, both conservative and invasive treatments are inconsistent and highly subjective. The book aims to highlight the main pathogenetic mechanisms leading to pain based on a thorough analysis of the lumbar spine anatomy and mechanics (including its vascular content) and a selection of published evidence converging towards an original integrated model. The result is a downgrading of back pain from a “non-specific” disease to a symptom and clarifying the underlying causes. The book presents an original pathogenetic model named CoVIn (Compressive-Venous-Inflammatory). The cornerstones of the model are a) the compression of nerve endings within the narrow spinal canal from disc herniation or arthritic spurs, b) local inflammation caused by discal material and/or local phlebitis and -most importantly- c) venous congestion of the Batson (epidural) plexus. The model explains the diversity of the clinical pictures: e.g., pain at rest vs. pain during spinal loading; pain unrelated to the severity of MRI or CT imaging; changes of pain (spontaneous or caused by treatments) with no changes in imaging, and others. Consistent with the model, a few physiotherapy treatments are proposed to widen the spinal canal and decongest local veins. These are “flexor” lumbar exercises, water exercises, and—first choice—Active Lumbar Traction (former “Autotraction”). Treatments targeting pain become a second-choice approach. Surgery is shown to be rational only after conservative treatments fail. Other rare causes of back pain, unrelated to the CoVin model, are overviewed and discussed. The book will interest Physical Medicine and Rehabilitation Physicians, Physiotherapists, Orthopedic and Trauma Surgeons, Neurosurgeons, Rheumatologists, Neurologists, and Family physicians.

Contents:

Part 1 Observing the Patient

1 Low Back Pain and Contradictions

2 The Flexion-Type Patient: Low Back Pain, Lumbosciatica, Lumbocruralgia

3 The Extension-Type Patient: typical clinical picture

Part 2 The Basis of Sciatic Pain

4 Neurology of Sciatic Pain

5 The Missing Link: Epidural Venous Stasis

Part 3 Explaining the Contradictions

6 Explaining the (few) different clinical pictures

7 Mysteries Explained

Part 4 An Integrated Pathogenetic Model and Some Special Cases

8 The compressive-venous-inflammatory model

9 Cases that are compatible with the CoVin model

10 Cases at the limit or outside the CoVin model

Part 5 Macro-Rationale of Non-Surgical Therapy

11 Pain therapies: why they are not the first choice

12 Therapies with exercise and manual, physical, instrumental, or pharmacological therapies

13 Reflections on Conservative Therapy

Appendix: When things don't add up.

Notes:

Description based on publisher supplied metadata and other sources.

ISBN:

9783031785344

3031785347

OCLC:

1485721685