Presentation
Sciatica presents with a range of symptoms which are often characteristic enough to make a diagnosis. Symptoms are mainly neurological and related to the musculoskeletal system.
Musculoskeletal symptoms
Symptoms begin with mild to moderate pain in the lower back and buttocks which radiates down the leg. There is numbness and a pins and needles sensation (paraesthesia) in the affected limb. Symptoms can be in just one limb or rarely, in both. The pain is sometimes so severe that the affected individual is in extreme discomfort and debilitated.
Neurological symptoms
Sciatica is always due to nerve involvement. The sciatic nerve may be directly involved as in the case of intervertebral disc herniation or protrusion or due to a tumor. Or the nerve may become indirectly involved due to a spasm or excessive contraction of the piriformis muscle, as in the piriformis syndrome [5]. It may also arise due to indirect nerve involvement in pregnancy.
Complications
- Irreversible nerve damage leading to persistent pain
- Chronic sciatica
- Partial or complete loss of sensation in the involved limb
- Immobility
- Incompletely healing lower limb injuries
Risk factors
Some people are more at risk for developing sciatica. Common risk factors include:
- Extremely tall people
- Pregnant females
- Improper exercising
- Lower spinal lesions
- Tumors in the lumbar or sacral region
- Degenerative bone or muscle diseases
- Old age
- Athletes
- Sedentary lifestyle
Entire Body System
- Pain
It refers to pain that begins in the hip and buttocks and continues all the way down the leg. This symptom is often accompanied by low back pain, which can be more or less severe than the leg pain. [back.com]
Sciatica causes pain, a burning sensation, numbness, or tingling radiating from the lower back and upper buttock down the back of the thigh to the back of the leg. The result is lumbar pain, buttock pain, hip pain, and leg pain. [medicinenet.com]
Acute pain lasting more than six weeks is one of the red flags of back pain, and requires prompt attention. By far, the most common cause of sciatica a herniated disc. [virginiamason.org]
Other symptoms include, but are not limited to: Lower back pain Pain in the rear or leg that intensifies when standing or sitting Hip pain Weakness, numbness or difficulty moving the leg or foot A constant pain on one side of the rear Sensations that [spinecare.luminhealth.com]
What does sciatica pain feel like? People describe sciatica pain in different ways, depending on its cause. Some people describe the pain as sharp, shooting, or jolts of pain. Others describe this pain as “burning,” "electric” or “stabbing.” [my.clevelandclinic.org]
- Weakness
The reason sciatica can cause lower back pain as well as leg pain and weakness is that your sciatic nerves control the muscles in the backs of your knees and lower legs. [everydayhealth.com]
Sciatica refers to pain, weakness, numbness or tingling in the leg. It is not a medical condition on its own, but rather the result of another medical problem. [virginiamason.org]
[…] or numbness in a leg or foot More serious symptoms associated with sciatica that may require immediate medical attention include: Continuing weakness in a leg or foot Numbness in groin or the buttocks Difficulty walking, standing or moving Loss of bowel [uvahealth.com]
You can test yourself for weakness that may be resulting from sciatica by trying to walk across the room on your heels. If you cannot hold up the affected foot, then weakness is indicated in the anterior lower leg musculature. [novocur.com]
When you have sciatica, you have pain, weakness, numbness, or tingling. It can start in the lower back and extend down your leg to your calf, foot, or even your toes. It’s usually on only one side of your body. [healthcare.utah.edu]
- Inflammation
Sciatica is pain that results from an inflammation of the sciatic nerve, which runs from the lower back down the back of each leg. It affects people differently, but it can be excruciating in some cases. [henryford.com]
ESI is not always successful in relieving symptoms of inflammation. They are used only when conservative treatments have failed. [depuysynthes.com]
The chronic inflammation that occurs in and around the spine with this disease can cause symptoms such as sciatica. [ansellchiropractic.com.au]
This may be an inflammation of the sciatic nerve: the sciatica. [en.eme-physio.com]
In contrast, if your symptoms of tightness and tenderness are never felt outside of the middle of your affected buttock, then it’s more likely that you have piriformis syndrome, an inflammation of the piriformis, a small stabilizing muscle that lies deep [runnersworld.com]
- Falling
Sciatica in Cuyahoga Falls Sciatica, which is also known as sciatic neuralgia, is a condition that causes pain in the lower back, down the back of the leg, and into the foot. [tubbschiropractic.com]
Sciatica can come on gradually over time, but it can also be triggered by very small, everyday movements – like bending over to one side to pick something up – or from sudden traumas or incidents, like falling off a ladder and landing on your back. [thephysiocompany.com]
A 35-year-old previously symptom-free woman presented sudden right sciatica and weakness of her right leg following a fall with impact to her left foot. [ncbi.nlm.nih.gov]
I’d gingerly toss and turn, re-situating pillows and limbs — icepacks and heating pads — until the pain was dull enough to let me fall asleep. If I was lucky, I’d fall asleep and stay asleep for an hour. [medium.com]
Piriformis syndrome can worsen if you sit for long periods, fall, or experience a car crash. Risk Factors for Developing Sciatica Certain behaviors or factors can raise your risk of developing sciatica. [healthline.com]
- Severe Pain
He subsequently attended ED the following day in severe pain and bilateral sciatic symptoms, but denied symptoms of neurogenic bowel/bladder disturbance. [ncbi.nlm.nih.gov]
The pain may be constant or may come and go. Also, the pain is usually more severe in your leg compared to your lower back. The pain may feel worse if you sit or stand for long periods of time, when you stand up and when your twist your upper body. [my.clevelandclinic.org]
If your pain lasts for more than 3 months, it might be time for surgery. See your doctor immediately if your sciatica causes severe pain and weakness, numbness, and loss of bladder or bowel function. [webmd.com]
Respiratoric
- Cough
[…] such as: Fractures in the back Tumors Infections Metabolic problems, such as diabetes Sciatica Symptoms Sciatica can cause: Burning, tingling or a shooting pain down the back of one leg Pain in one leg or buttock may get worse with: Sitting Standing up Coughing [uvahealth.com]
Characteristically sciatica is exacerbated by coughing, straining, sneezing, or laughing (2). The lifetime incidence of sciatica varies from 13-40% while the annual incidence of an episode of sciatica can be between 1-5% (2). [gpnotebook.co.uk]
The pain of sciatica may become more severe with coughing, sneezing, and flexion of the neck. [britannica.com]
Sciatic pain may get worse with sitting, walking, bending, sneezing, or coughing. Diagnosing and Treating Sciatica A diagnosis of sciatica is usually made during a history and physical examination. Your doctor will ask you about your pain. [everydayhealth.com]
You may have pain, especially when you move, sneeze, or cough. You may also have weakness, "pins and needles" numbness, or a burning or tingling sensation down your leg. You are most likely to get sciatica between the ages of 30 and 50 years. [orthoinfo.aaos.org]
- Sneezing
Fractures in the back Tumors Infections Metabolic problems, such as diabetes Sciatica Symptoms Sciatica can cause: Burning, tingling or a shooting pain down the back of one leg Pain in one leg or buttock may get worse with: Sitting Standing up Coughing Sneezing [uvahealth.com]
Characteristically sciatica is exacerbated by coughing, straining, sneezing, or laughing (2). The lifetime incidence of sciatica varies from 13-40% while the annual incidence of an episode of sciatica can be between 1-5% (2). [gpnotebook.co.uk]
The pain of sciatica may become more severe with coughing, sneezing, and flexion of the neck. [britannica.com]
Sciatic pain may get worse with sitting, walking, bending, sneezing, or coughing. Diagnosing and Treating Sciatica A diagnosis of sciatica is usually made during a history and physical examination. Your doctor will ask you about your pain. [everydayhealth.com]
You may have pain, especially when you move, sneeze, or cough. You may also have weakness, "pins and needles" numbness, or a burning or tingling sensation down your leg. You are most likely to get sciatica between the ages of 30 and 50 years. [orthoinfo.aaos.org]
Skin
- Pruritus
RESULTS: Beyond the planned enrollment of 44 subjects, four additional subjects were enrolled into to the intravenous BG00010 200 μg/kg cohort after one original subject experienced mild generalized pruritus. [ncbi.nlm.nih.gov]
Pruritus and dysesthesia. In: Dermatology. 3rd ed. Philadelphia, Pa.: Saunders Elsevier; 2012. https://www.clinicalkey.com. Accessed July 27, 2016. Goldsmith LA, et al., eds. Atopic dermatitis. [mayoclinic.org]
In medical terminology, itching is known as pruritus. Generalized itch that occurs all over the body is often more difficult to treat than localized itch. [medicinenet.com]
Musculoskeletal
- Back Pain
This type of lower back pain is less common than other causes and conditions that produce back pain. For instance, sporting activities, recreational activities, and heavy labor can cause back and leg pain, which is commonly misdiagnosed as sciatica. [back.com]
Symptoms of sciatica may include: Lower back pain Shooting pain down the back of the leg Burning leg and back pain Tingling and numbness of the back or leg Weakness of the back or leg Not everyone has experiences back pain with sciatica, notes Dr. [everydayhealth.com]
The term sciatica is oftentimes used incorrectly to explain leg pain, low back pain and other sciatica symptoms. [spine-health.com]
Sciatica causes pain, a burning sensation, numbness, or tingling radiating from the lower back and upper buttock down the back of the thigh to the back of the leg. The result is lumbar pain, buttock pain, hip pain, and leg pain. [medicinenet.com]
If you have low back pain, then you know how painful and debilitating this condition can be. [verywell.com]
- Low Back Pain
The term sciatica is oftentimes used incorrectly to explain leg pain, low back pain and other sciatica symptoms. [spine-health.com]
[…] with acute low back pain is nearly impossible. [verywell.com]
Sometimes the sciatic pain radiates around the hip or buttock to feel like hip pain. While sciatica is often associated with lower back pain (lumbago), it can be present without low back pain. [medicinenet.com]
About Sciatica Many people have low back pain that keeps on coming back. Often, an exact cause cannot be determined and the pain goes away on its own after a few days or a couple of weeks. [web.archive.org]
Linton, Low back pain, Nature Reviews Disease Primers, 10.1038/s41572-018-0052-1, 4, 1, (2018). [doi.org]
- Leg Pain
The term sciatica is oftentimes used incorrectly to explain leg pain, low back pain and other sciatica symptoms. [spine-health.com]
Sciatica usually causes pain and muscle spasms that extend down the leg. Burning, tingling or numbness can also occur. [mhealth.org]
Outcome measures were recovery and leg pain severity. Recovery was registered on a 7-point Likert scale. Complete/near complete recovery was considered a satisfactory outcome. Leg pain severity was measured on a 0- to 100-mm visual analog scale. [ncbi.nlm.nih.gov]
It refers to pain that begins in the hip and buttocks and continues all the way down the leg. This symptom is often accompanied by low back pain, which can be more or less severe than the leg pain. [back.com]
- Fracture
Sciatica can also result from spinal stenosis, Piriformis syndrome (which involves compression in the buttock muscles), spinal tumors and pelvic injuries or fractures. You may hear the word "radiculopathy" in relation to sciatica. [virginiamason.org]
Smoking History of low back problems Anxiety and depression Occupational factors, such as: Heavy manual labor Heavy lifting Exposure to vibrations A job that requires standing for long periods of time and forward bending Health conditions, such as: Fractures [uvahealth.com]
We present an unusual case of sciatic nerve compression in a 14-year-old-girl that was caused by an avulsion fracture of the ischial tuberosity. The compression was relieved by surgical excision of the avulsed ischial tuberosity. [ncbi.nlm.nih.gov]
Causes of sciatica include A ruptured intervertebral disk Narrowing of the spinal canal that puts pressure on the nerve, called spinal stenosis An injury such as a pelvic fracture. In many cases no cause can be found. [medlineplus.gov]
Causes Some of the common causes of sciatica include herniated disc, piriformis syndrome, hip injury or fracture and tumors of the lumbar spine. [middlesexortho.com]
- Muscle Spasm
Other causes include spinal stenosis (narrowing of the spinal canal) or spasms in a muscle (the piriformis muscle in the buttocks) that the sciatic nerve passes through. Sciatica usually causes pain and muscle spasms that extend down the leg. [mhealth.org]
After that, heat works best to relax muscle spasms and reduce pain," explains Kovacs. [everydayhealth.com]
Muscle spasm Patients with sciatica may suffer from muscle spasms along the lower limb and the back. This symptom is a sign that the patient suffers from disc prolapse. [betahealthy.com]
Muscle relaxants, such as cyclobenzaprine (Flexeril®), might be prescribed to relieve the discomfort associated with muscle spasms. However, these medicines might cause confusion in older people. [my.clevelandclinic.org]
Urogenital
- Incontinence
Patients experiencing bladder or bowel incontinence, weakness in the legs and feet, extreme numbness or severe nerve impingement should seek medical help immediately. [bamapain.com]
Patients who experience bowel or bladder incontinence (inability to control the bowel or bladder) and/or increasing weakness or loss of sensation in the legs should see a doctor immediately. See Cauda Equina Syndrome [spine-health.com]
Sciatica can also be associated with muscle failure and urinary incontinence. [goodstrict.com]
This self-treatment plan starts with the Soft Ball Foot Treatment and is also great for anyone who’s dealing with a hip replacement, SI issues, incontinence, or who had a hysterectomy. [meltmethod.com]
Neurologic
- Sciatica
[…] numbness in the affected leg Sciatica Non-Surgical Treatment Options How you address sciatica depends largely upon the root cause. [spinecare.luminhealth.com]
True sciatica is an injury or irritation to the sciatic nerve, which starts in your buttock/gluteal area. What is sciatica? Sciatica is nerve pain from an injury or irritation to the sciatic nerve, which originates in your buttock/gluteal area. [my.clevelandclinic.org]
Alleviating Sciatica Pain Because sciatica is the result of another medical condition, treatment focuses on that condition, whether a herniated disc, spinal stenosis or something else. [virginiamason.org]
Sciatica Treatment Options In many cases, sciatica will improve and go away with time. Initial treatment usually focuses on medicines and exercises to relieve pain. Additional treatment for sciatica depends on what is causing the nerve irritation. [hoag.org]
- Irritability
Sometimes sciatica can occur because of irritation of the sciatic nerve during pregnancy. [medicinenet.com]
Additional treatment for sciatica depends on what is causing the nerve irritation. [hoag.org]
When spinal stenosis occurs, tension is placed on the spinal cord and may irritate and strain local nerves. [spinecare.luminhealth.com]
This can lead to nerve root irritation and sciatic pain in one or both legs. If the disc is damaged severely inflammatory proteins from inside the centre of the disc can irritate the nerve root causing sciatic pain. 3. [ansellchiropractic.com.au]
True sciatica is an injury or irritation to the sciatic nerve, which starts in your buttock/gluteal area. What is sciatica? Sciatica is nerve pain from an injury or irritation to the sciatic nerve, which originates in your buttock/gluteal area. [my.clevelandclinic.org]
- Tingling
Weakness, tingling, or numbness in the leg may also occur. Hoag's Spine Neurosurgery program offers a comprehensive treatment program for patients with Sciatica. [hoag.org]
Sciatica refers to pain, weakness, numbness or tingling in the leg. It is not a medical condition on its own, but rather the result of another medical problem. [virginiamason.org]
Burning, tingling or numbness can also occur. [mhealth.org]
You may only experience tingling and numbness. It all depends on which roots of the nerve are affected. “Although sciatica can occur on both sides, it is usually one-sided," she adds. [everydayhealth.com]
Sciatica is pain, tingling, or numbness produced by an irritation of the nerve roots that lead to the sciatic nerve. The sciatic nerve is formed by the nerve roots coming out of the spinal cord into the lower back. [stanfordhealthcare.org]
- Burning Sensation
Sensations can include: Mild tingling Sharp pain Weakness Dull ache Burning sensation Numbness Pain often starts slowly, and may get worse at different times of day or after standing or sitting for long periods. [virginiamason.org]
It may feel like a mild tingling, dull ache, or burning sensation. In some cases, the pain is severe enough to make a person unable to move. [wakehealth.edu]
The pain varies from aching pain to stabbing pain and even burning sensation or excruciating pain. If the pain is severe and started after a fall or trauma, maybe it’s because of a fracture of a bone along the course of the sciatic nerve. [betahealthy.com]
Sciatica Symptoms Symptoms often include: Mild tingling sensations throughout the leg, calf or foot Dull, aching pain throughout the leg, calf or foot Burning sensations, known as lumbar radiculopathy Sharp pain in parts in the leg or hip Weakness and [spinecare.luminhealth.com]
The pain can vary widely, from a mild ache to a sharp, burning sensation or excruciating pain. Sometimes it can feel like a jolt or electric shock. It can be worse when you cough or sneeze, and prolonged sitting can aggravate symptoms. [mayoclinic.org]
- Neuralgia
From Wikidata Jump to navigation Jump to search medical condition with pain down the leg from the lower back sciatic neuralgia Bilateral Sciatica Neuralgia, Sciatic Neuralgias, Sciatic Bilateral Sciaticas Sciatica, Bilateral Sciatic Neuralgias edit English [wikidata.org]
Isquiática, Isquiática, Ciática, Neuralgia Ciática Spanish Enfermedad de Cotugno, Neuralgia ciática, Isquialgia, ciática (trastorno), ciática, neuralgia - neuritis del nervio ciático mayor, neuralgia ciática, Ciática, Neuralgia Ciática Japanese コトゥーニョ [fpnotebook.com]
Word Sciatica Hindi Meaningकटिस्नायुशूल, गृध्रसी, पृथुस्नायुशूल neuralgia along the sciatic nerve / Neuralgia of the sciatic nerve, an affection characterized by paroxysmal attacks of pain in the buttock, back of the thigh, or in the leg or foot, following [studysite.org]
Gabapentin has been approved in the United States for the treatment of epilepsy and postherpetic neuralgia. [ncbi.nlm.nih.gov]
Workup
Diagnosis is based on a complete history and physical examination.
A complete work up may include:
Checking for Lasegue's sign: In this test, the involved leg is passively flexed between 30 to 70 degrees and if the pain appears or aggravates, it is taken to be positive for sciatica.
Computerized Tomography Scan (CT): A CT scan be be conducted to check for possible causes of sciatica like spinal disc herniation or lumbar canal stenosis [7].
Magnetic Resonance Imaging (MRI): An MRI may be conducted for a more through scan for spinal lesions or tumors.
Treatment
Treatment for sciatica is prolonged bed rest, physiotherapy and pain relieving medications [8], if needed. The pain subsides on its own if the underlying cause is detected and treated.
Prognosis
Sciatic pain occurs in response to obvious trauma, or due to internal wear and tear. It may arise due to jerky movements or posture change which may somehow irritate the sciatic nerve [6].
Whatever the cause may be, the pain is often sudden in onset and increases gradually but may subside after some time.
Sciatica, though not necessarily continuous for life, does have a tendency to reoccur, often without any warning or predisposing factor. The pain lasts around for a few days to a few weeks and then subsides. Proper bed rest, medication and physiotherapy may speed up the process of alleviating the pain.
Etiology
Sciatica is caused by any disease or pressure or trauma that results in compression of the nerve roots from L4 to S3. The symptoms of sciatica can be presented with the following conditions [2]:
- Spinal Disc Herniation: The intervertebral discs are composed of an inner soft portion called nucleus pulposus surrounded by an outer thicker and stronger ring called annulus fibrosus. The integrity of the outer fibrous ring keeps the central portion in place. If there is a tear, especially on the posterio-lateral aspect of the ring, the inner nucleus pulposus may herniate outwards. This herniation may put pressure on the nerve roots, or cause an inflammatory response which may damage the nerve roots. Either way, due to spinal disc herniation, sciatica may arise.
- Spinal Disc Protrusion or Slip Disc: This condition is somewhat similar to the spinal disc herniation. The difference is that the annular ring, in this case, is intact. The nucleus pulposus does not squeeze out so there is no herniation. Instead, due to increased pressure on the lumbar and sacral vertebras, and thus the intervertebral discs, the disc itself slightly slips out. This causes a protrusion, commonly in the posterior aspect, called a disc slip. This protrusion of the intervertebral disc puts pressure on the surrounding nerve roots which then causes sciatica.
- Degenerative Disc Disease: This condition is a result of either aging or due to trauma which causes unresolved inflammation in the lumbar area leading to damage to the intervertebral discs. As a result of the inflammatory process, or sometimes direct trauma, the weakened disc is prone to cause nerve damage, sometimes leading to sciatica.
- Lumbar Spinal Stenosis: It is a condition in which factors like slipped disc, inflammation, tumors, bony spurs, etc cause the spinal canal to narrow down. This narrowing or stenosis of the lumbar spinal canal causes damage to the cauda equina and/or the nerve roots, leading to sciatica.
- Piriformis Syndrome: In about 15% of people, the sciatic nerve travels through or underneath the piriformis muscle. So a contraction or spasm in the muscle may put excessive pressure on the nerve causing sciatic pain to arise.
- Pregnancy: In some pregnancies, the weight of the fetus may cause pressure on the sciatic nerve leading to sciatica.
- Other: Tumors may increase the pressure of the vertebral canal or directly impinge upon the sciatic nerve roots causing sciatica. Injury or trauma to the spine may also result in lifelong pain in the lower back, buttocks and legs.
Epidemiology
None of the studies conducted have been specific for sciatica, but rather have been based on the diseases that may cause sciatica, such as lumbar disc herniation, etc. So the exact occurrence of sciatica is unknown.
Race: Sciatica has no known predilection to race or cast.
Ag: It is more common in older people due to age-related wear and tear of the spinal discs leading to herniation, and weakening of the vertebral canal leading to lumbar canal stenosis [1].
Sex: There are no definite studies declaring a predisposition in either sex, however, some studies suggest a higher prevalence in males.
Pathophysiology
As mentioned earlier, the sciatic nerve arises from 5 nerve roots, beginning from lumbar 4th to sacral 3rd. Sometimes, nerve fibres from L3 may also be involved. The lumbo-sacral plexus forms in the substance of the psoas muscle and the sciatic nerve, which arises when these nerve roots unite, passes beneath the piriformis muscle, through the greater sciatic foramen into the leg [3].
Damage to the nerve roots, due to any number of causes like those mentioned in the previous segment, leads to pain in the regions the nerve traverses. These regions include the lower back, buttocks, thighs, legs and feet.
Sometimes, the whole lower limb may be involved, sometimes just the proximal part or the distal portion of the limb, depending upon the nerve root involved. Sciatica does not necessarily arise on both lower limbs. It is often present in just one limb, unless there is a significant spinal injury involved [4].
Prevention
By avoiding the common risk factors such as improper exercising, sudden, twisting movements that may damage the nerve and a sedentary life style, sciatica can be prevented.
Also taking a healthy diet, so as to prevent bone diseases and muscle weakening, may decrease the chances of developing sciatica [10].
Summary
Sciatica, or sciatic neuritis, is a common condition that affects the whole or part of the sciatic nerve. Damage or compression to any one of the nerve roots causes characteristic and often progressive symptoms to appear.
The sciatic nerve is the largest and thickest nerve of the body. It is formed from L4 to S3 segments of the sacral plexus, which emerge out from the lower spinal cord and merge together in front of the piriformis muscle. The nerve then passes through the greater sciatic foramen and leaves the pelvis, entering the back of the leg. While moving downwards, the sciatic nerve divides into its two branches:
Common fibular nerve: Which courses in and supplies the anterior and lateral compartments of the leg. It also innervates the dorsum of the foot.
Tibial nerve: Which travels in the posterior compartment of the leg, supplying both the muscles and the skin. It also gives sensory innervation to the sole of the foot.
If any one of the five nerve roots is compressed, either when it emerges out of the cord or during the path where it unites with the others, it causes sciatica.
The symptoms include sudden, mild to severe pain in the lower back, moving downwards in the buttocks, back of the leg and sometimes as far as to the foot. The pain may or may not be accompanied with numbness and paraesthesia.
Patient Information
Definition
Sciatica is referred to pain in the lower back which radiates to the buttocks and one or both the legs. It is accompanied by numbness, tingling and a pins and needles sensation in the affected limb.
Cause
It is due to irritation, damage or compression of the sciatic nerve, which supplies the lower limb muscles and skin. It arises most commonly due to spinal disc herniation or protrusion (slipped disc).
Signs and Symptoms
Numbness, tingling and pain in the lower limbs are the presenting symptoms. The pain may be localised to just the back, or involving the entire leg; from the hip to the foot. The severity of the pain is also varying. It may be mild to extremely severe that it immobilises the patient.
Treatment
It includes prolonged bed rest and physiotherapy. The underlying cause should be identified and treated [9].
Prevention
With the right lifestyle and diet, and avoidance of the risk factors may prevent the occurrence of sciatica.
References
- Anderssen GBJ. Epidemiologic features of chronic low back pain. Lancet. 1999;354:581-5
- Nachemson Al, Waddell G, Norland AL. Nachemson AL, Jonsson E (eds.). Epidemiology of Neck and Low Back Pain, in. Neck and Back Pain: The scientific evidence of causes, diagnoses, and treatment. Philadelphia: Lippincott Williams & Wilkins; 2000:165-187.
- Mooney V. Presidential address. International Society for the Study of the Lumbar Spine. Dallas, 1986. Where is the pain coming from?. Spine (Phila Pa 1976). Oct 1987;12(8):754-9.
- Wheeler AH, Murrey DB. Chronic lumbar spine and radicular pain: pathophysiology and treatment. Curr Pain Headache. 2001;Rep 6:97-105.
- Mooney V. Presidential address. International Society for the Study of the Lumbar Spine. Dallas, 1986. Where is the pain coming from?. Spine (Phila Pa 1976). Oct 1987;12(8):754-9.
- Haldeman S. North American Spine Society: failure of the pathology model to predict back pain. Spine (Phila Pa 1976). Jul 1990;15(7):718-24.
- National Center for Health Statistics (1976):. Surgical operations in short stay hospitals by diagnosis, United States. 1973. Series 13, No.24.
- van Tulder MW, Scholten RJ, Koes BW, Deyo RA. Nonsteroidal anti-inflammatory drugs for low back pain: a systematic review within the framework of the Cochrane Collaboration Back Review Group. Spine (Phila Pa 1976). Oct 1 2000;25(19):2501-13
- Breivik H, Hesla PE, Molnar I, et al. Treatment of chronic low back pain and sciatica. Comparison of caudal epidural injections of bupivacaine and methylprednisolone with bupivacaine followed by saline. In: Bonica JJ, Albe-Fessard D, eds. Advances in pain research and therapy. Vol 1. New York: Raven Press; 1976:927-32.
- Weber H. Lumbar disc herniation. A controlled, prospective study with ten years of observation. Spine (Phila Pa 1976). Mar 1983;8(2):131-40.