Ancillary Procedures

The selection of laboratory tests depends on the nature of the back problem and the degree of one's suspicion of the presence of disease. Helpful measurements include complete blood count, sedimentation rate,

Sciatic Notch Tenderness

FIG. 11-1 (1) Costovertebral angle (renal pain). (2) Spinous process and interspinous ligament. (3) Region of L5-S1 articular facet (facet joint pain). (4) Dorsum of sacrum. (5) Region of iliac crest. (6) Iliolumbar angle.

(7) Spinous processes of fifth lumbar to first sacral vertebrae (tenderness = metastasis, faulty posture or occasionally spina bifida occulta).

(8) Region between posterior superior and posterior inferior spines. Sacroiliac ligaments (tenderness = sacroiliac sprain, often tender with fifth lumbar to first sacral disc). (9) Sacrococcygeal junction (tenderness = sacrococcygeal injury, i.e., sprain or fracture). (10) Region of sacrosciatic notch (tenderness = fourth to fifth lumbar disc rupture and sacroiliac sprain). (11) Sciatic nerve trunk-sciatic notch (tenderness = ruptured lumbar disc or sciatic nerve lesion).

FIG. 11-1 (1) Costovertebral angle (renal pain). (2) Spinous process and interspinous ligament. (3) Region of L5-S1 articular facet (facet joint pain). (4) Dorsum of sacrum. (5) Region of iliac crest. (6) Iliolumbar angle.

(7) Spinous processes of fifth lumbar to first sacral vertebrae (tenderness = metastasis, faulty posture or occasionally spina bifida occulta).

(8) Region between posterior superior and posterior inferior spines. Sacroiliac ligaments (tenderness = sacroiliac sprain, often tender with fifth lumbar to first sacral disc). (9) Sacrococcygeal junction (tenderness = sacrococcygeal injury, i.e., sprain or fracture). (10) Region of sacrosciatic notch (tenderness = fourth to fifth lumbar disc rupture and sacroiliac sprain). (11) Sciatic nerve trunk-sciatic notch (tenderness = ruptured lumbar disc or sciatic nerve lesion).

serum immunoelectrophoresis, Ca, P, acid and alkaline phosphatase, prostate-specific antigen (if metastatic carcinoma of the prostate is a diagnostic possibility), and rheumatoid factor. Tuberculin skin test and, in endemic areas, Brucella antibody test should be carried out if there is a suspicion of chronic infectious disease. Plain films of the spine, bone scans, CT scans with or without enhancement or myelography,

MRI, and, in cases of discogenic disease, electromyography, nerve conduction studies, and sensory evoked potentials are important ancillary procedures. Myelography is customarily reserved for patients in whom there is a strong suspicion of ruptured disc, tumor, or spinal stenosis and a likelihood of surgery.

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