Table Of Content� - .
ClinicAanla tomoyf t he
LumbaSrp inaen dS acrum
ForE lst'Vier
SeniCoorm missioEndiintgSo ra:r eWnoal afard
ProjeDcetvel opmeMlrlmto geCrl:a iWriel son
ProjeMcatl lagMeorr:v eDne an
DesigJlul:d Wirtihg ht
IllustrMaatliionngB erurce: Hogarth
ClinAincaatlo my
oft hLeu mbSapri ne
andS acrum
NikolBaoig duk
BSe( Med)M,B BSP hD,M D,D SeD,i pAnDaitp P aiMne d,F AFRMF AFMM,
FFPM( ANZCA)
ProfesosfPao irn M ediciUnnei,v erosfiN teyw castalned,
HeadD,e partmoefnC tl iniRceasle arch,
RoyaNle wcasHtolsep iNteawfc,a stle,
NewS outWha leAs,u stralia.
Forewboyr d
StephMe.nE ndres
MD DABPM
PresidIenntte,rn ationaI/nStpeirnvee Snotciioenty,
AssociCalfit:n iPcroolf esosfAo nre sthesiology,
UniverosfiW tiys conMseidni cSaclh oaonld
AssociCaltien iPcraolf esosfNo urr sing,
UniverosfiW tiys confseiunC ,l aire.
WisconUsSiAn.,
FOURTEHD ITION
!I��'.'
;iI
ELSEVIER
CilURClI1LL
LlvrNG�TONI'
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UVINGSTONE
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v
Contents
Forrworvdi i 9.T hel umbar musacnldet sh eifra scia9e7
Prefatcoet hef ourtehd itioinx
10.N erveosf t he lumbsapri ne1 23
Prefatcoet hef iresdti tioxni
11.B loosdu pployf t hel umbasrp ine1 41
1.T hel umbavre rtebrae
12.E mbryoloagnyd d evelopmen1t4 9
2.T hei nterbojdoyi natn dt hei ntervertebral
discs1 1 13.A gec hangeisn t hel umbasrp ine1 65
3.T hez ygapophyjsoiianlt s2 9 14.T hes acroiljioaicn t1 73
4.T hel igamenotfst hel umbasrp ine3 9 15.L owb ackp ain 183
5.T hel umbalro rdosainsdt he 16.lnstabi2l1i7ty
vertebcraanla l5 1
17.R adiograpahniact omy2 27
6.T hes acrum5 9
Appendix2 37
7.B asibci omechani6c3s
Index2 41
8.M ovementosf t hel umbasrp ine7 7
vii
Foreword
Whena sketdow ritteh eF orewotrodt hef ourth editioDnu rinmgy timea sC hairmaonf th e Education
ofC linical Aonf1a 1tL1ou1."mm yb aSrp ilalnedS acruImf elt Committfeoe r[ SISI, w itnesseidn crediabdlvea nce
honoureadn dp rivileIgh eadv.ek nowna ndw orked mentisn t het echnical comopfs lpeixniiatnlyt ervention
withD rN ikIl ogdufko rt hel as1t0 y earasn,d I h ave procedures. Howwiettvhh eiris,n creiasnce o mplexity
alwayrse spechtiemdf orh isa cademiinct egrity. oft echnjqcuaemsea ni ncreaisnce o mplicattioto hnes
Historictahlelrya,p eutic iwnejreedc otnieob nyas n patienAst .f luoroscopgiuciadlelsdyp intaelc hniques
anaesthesioilno rgaei csotv erroyo mi nb etweecna ses. becammeo rep opulaarn da cceptceadd,a vecro urses
Most procedures dwoenree u sing tshuer faces ponsorbeydm anyd ifferoerngta nizatsitoanrstt eod
anatomlya ndmaraknsd a sensoef f eetlo g uidteh e cropu p allov ert heU niteSdt ateMsy. c oncerwna s
needlteo t hes upposetda rget aread.o sLeaosrf g e thamta nyo ft hesceourses taughtth e enstpiercet rum
locaanla esthaentdis ct erowiedrse u sedt oe nsurteh at ofs pinailn terventteicohnn iquienls e stsh ant wo
atl easat p ortioofnt hei njectwaotuel dg ett ot he daysw,i thu suallleys tsh an oneh ours penotn b asic
suspectpeadi ng eneratTohri.si ,n m anyc asewsa,s anatomayn db iomechanictsh es opfi neM.o ret ime
effectiinv et reaticnegr taaicnu tei nflammatorwya ss pendti scusshionwg t oc hargaen dh owt oc ode
conditiaolnosn tgh es pinbeu,t i tc ertaiwnalsyn ever thans penotn r adiograapnhaitco moyft hes pine.
intendteodb ea techniqtuhea hta da nyd iagnostic Duet ot hiosb servatiaosnw ,e lals r eporotfsm ore
value. complicattioop nast ienftrso ms pinailn terventions,
Overa decadaeg ot,h anktsot hee fforotfps h ysicianIsS ImSa dea concentreaftfeodtr otg ob ackt ob asics;
sucha sC harlAiper ilRli,c kD erbya ndN ikIl ogduk event hem oste xperienscpeidn ailn jectiwoonuilsdt
(foundifnagt heorfst heIn ternationSapli neI nterhaved ifficluelatrnyi nogrm asterienvge na fourtohf
ventiSoocni etyf)l,u oroscwoapssy h ownt ob eo fg reat whatw as presenattet dh esmeu ltipmloed ality
valuneo lo nlyf or verinfeyeidnlgpe l acemefnotr courseIns l.i ghotft hiwse, felt thew abyte ost te ach
therapeuitnijce ctibountsi ,t sd iagnostuitci litsyp inailn terventwiaosn bsy implementian vge ry
alsob ecameo bviouAss. a membero fI SISi,nt he structutrieeodrf c adavecro ursewsh,i chb egawni th
earl1y9905 Is awa reneweidn terienss tp inaen atomy basiscc ienacned a natomoyf t hes pinei,n cluding
as wella s itsa ccompanyimnugs culoskelertaadli ograpahniact omays w ella sv eryb asilcu mbar
componentPsh.y siciaatntse nditnhgee arlcya daver ands acrianlj ectiWoen asl.s foe litti mperattihvaeat l l
coursfeosrt hef irtsitm ceo ulsede w herteh eti po ft he studensthso ulsdt arwti thb asiscc ienacned l umbar
needlwea sg oingI.no rdetro u ndersteaxnadc twlhya t courseasn do nlyt henb e qualiftioead d vancteo
was goingo n,a revieowf b asiscp inaaln atomy compleaxn atomayn ds pinianl jecttieocnh niqAuess .
and biomechanwiacss i mperatiTveex.t ssu cha s thesceo ursbeesc ame mosrteru ctuarnedod r ganized,
Dr Bogduk'Cs/ i"iAenaalt omoyf t lteL umbaSrp ine we fountdh aDtr B ogdukb'oso kC,[ il/Ai1cIaall oomfy
becamree quired reiano dridnegtr o g raswph att hey theL limbSapri "bee,c amneo to nlyr equirreeda ding,
weres eeinagn d doingw itht hen eedleM.o re buti tw ast hek eyr eferefnocrei nstructtoor resv iew
importanttelxyt,ss u cha st heswee res ignifiicna ntp riotrot eachitnhgec ourses.
helpitnhgei nterventiuonndaelrissttat nhder esponses Thet iminogft hifso urtehd itiiospn e rfefcotrn,o w
thesya wt ot hei njections. we haver eachetdh ea geo f' minimalilnyv asive'
viiiF OREWORD
proceduruesse dt ot repata igne neratoofrt sh es pine.I wasr emindehdo w importaintit s t oh avea firm
Chapterosn dispca ina ndp ostereiloerm enpta in understandoiftn hgeb asisct ructoufrt eh es pinaen d
strensost o nlyt hea natomoyf t heses tructubruets itsi nnervatiionno rdetro t reapta tienIt csa.n not
alsroe vietwh ep athophysioolfto hgeyd egenerativiem aginaen yonep lacingn eedles ino r arountdh e
procesasn d itsr elationsthoi ppa in.M ore tissue laanydne erusr aell emenotsf t hes pinwei thout
importantthleysec. h aptesrtsr ewshsa tb iomechanichaalv inagf irgmr asapst ow hatt hes horantd long-term
changemsa y occura sa resuolftd oindge structivefef ecmtasybe asa r esuolftt hesper ocedurIeh si.g hly
procedures. recommentdh ibso okt oa nyp hysicoirah ne alctahr e
Afterre adintgh ef ourtehd itiionnp reparitnog providienrv olviensd p incea rAe .f irumn derstanding
writteh iFso rewor1da,m , humblebdy h ow much1 oft hibso okw ilplr ovidaen ys pinailn terventionist
havel earne(do rh owm uchI h avef orgottaebno)ut th e witht hef oundatnieocne ssatrody i agnoasned t reat
basic anaatnodmb yi omechanoiftc hse l wnbasrp ine patienwtist hs pinpaali n.
ands acrumI. f ound myself leaanrndir negl earning
many thiIn cgosu lad pplyo n a dailbya sitso m y StepheMn. E ndres
practoifcs ep inianlt erventainodpn asi mna nagement. EauC lair2e00,5
L
ix
Prefatcote h ef ouretdhi tion
Anatomyc hangelsi t.t Tlhee structuorfeb ones, them ajocrh angeisnt hifso urtehd itioocnc uirn t he
joints, ligammeunstcsl erasen mda intshe s amea si t chaptepresr taintiotn hgec auseosfb acpka inO.v ert he
alwayhsa sb eenI.t b ecomedsi ffictuhletr,e fotroe ,f irstth reeed itiocnesr,t atihne mees mergeadn d
answear publisherre'qsu efsot ra newe ditioItn . evolveTdh.e y hacvoen tinuteodd o so . Fors ome, such
seemsa rtifitcoi aamle nda textw hent hes ubjecta sz ygapophysjioailnp ta in, mroercee ndta ta are
mattehra sn ots ubstanticahlalnyg eFdr.o mt imet o soberiTnhge.p revaleonfcz ey gapophyjsoiianlpt a in
timeh,o wevenre,w insighatrseb roughttol ighotr, mayn otb ea sh igahs p revioubsellyi evCeodn.v ersely,
erroorfso bservatiinto hnep asatr ec orrectMeidn.o r thea mounotf d atao nd iscogepnaiichn asi ncreased.
though tmhaeysb ee ,t heriesm eriitn b ringitnhge m Whatw asv enturaesda c onceipntt hef iresdti tihoans
tol ight. becommeo rec onsolidSattueddi.he asv ep rogressively
Therhea sb eenn on eedt oc hangteh ef undamentaslu pporttehdem orpholoagnyd d iagnoosifis n ternal
thrusotft hibso oks inciet sf iresdti tioTnh.eb asic disdci sruptiRoenc.en stt udiheasv ee stablisihtesd
structouftr heel umbasrp inhea sn otc hangeFdo.rt he biophysaincdsa etiology.
fouretdhi tion,m ionnolcryh angheasv eb eenm adei n Botha sa ne ducational saenrdtv oim caek,et hef ourth
thossee ctipoenrst aintiomn ogr pholoagnydf unctione.d itidoins tinctiavt eo,t anlelwyc hapthearsb eena dded.
The structuarned embryoloogfyt hei liolumbaIrtc overtshe r adiograapnhaict omoyft hel umbasrp ine.
ligamecnotn tintuoeb se c ontroverNseiwa olb.s ervaItd oes nota ddressp atholobguyti te xplaihnosw a
tionosn t hef ascicaunlaatro moyft heq uadratluusm knowledogfea natomcya npe rmitp ractitiownheora sr e
borumh avea ppeareNde.r vehsa veb eens hownt o notr adiologtiobs etsc omfortawbiltehr eadipngl ain
growi ntdoa mageidn tervertdeibsrcFasul.r thsetru diesr adiograopfth hsel umbasrp inTeh.i csh aptperro vides
haves hownt hes acroijloiianctt o h avea minimal ano verlitn kb etweenb asic sciaenndcc el inipcraalc tice.
rangoef m otion.
Wherem ajorc hangehsa veo ccurriesdi nt he NikolBaoig duk
applicaotfia onna tomtyo c liniicsaslu eAsc.c ordingly, NewcastNlSeW,, A ustralia
xi
Prefatcote h ef itre sdition
Lowb ack piasia nm ajoprr obleimnm edicianned c an isd escribienCd h apte5r.I nd escribtihnegl umbar
constitmuotreet han60% ofc onsultatiinpo rnisv atev ertebarnadet heijro intwse, h aveg oneb eyontdh e
physiotherparpayc tiYceet.t, h ee mphasigsi vetno usuaslc opoef t extbooofka sn atombyy e ndeavouring
spinaaln atomiyn c onventiocnoaulr siensa natomy toe xplawihny t hev ertebarnadet heicro mponenatrse
form edicaslt udenatnsd physiotheraipsin sotts constructtheewd a yt heayr e.
commensurwaitte ht hem agnituodfet hep roblem of Chapte6r s ummarisseosm eb asipcr incipolfe s
spinapla ini nc linipcraalc tiTchee.a natomoyf t he biomechanini cpsr eparatfioornt hes tudyo ft he
lumbars pineu suallcyo nstituotnelsy a small movementosft hel umbasrp inweh icish dealwti thi n
componeonfts ucch ourses. Chapte7r.C hapte8r p rovidaensa ccouonftt hel umbar
Havinbge eni nvolviends pinal resaenadri cnh backm usclwehsi cahr ed escribiened x haustdievtea il
teachimnegd icaslt udenatnsd p hysiotherabpoitsht sb ecausoef thei ncreascionngt emporairnyt erest
alu ndergraduaantdep ostgraduate wlee hvaevles ,a mongspth ysiotheraapnids ottsh erins physical
becomceo nsciooufhs o w littolfte h eb asiscc iencesm ediciinn et heb iomechanfiucnaclt iaonndss o-called
relattiont gh el umbasrp iniest aughttos tudenatnsd, dysfunctisotnaatolef st heb ackm uscles.
howd ifficiutcl atnbe too btaiinn formatwihoinc ih s Chapte9r san d 10d escritbheen erveasn db lood
availabbluet s cattered thar oduigvhe rsiotfy supployf t hel umbasrp inaen,d i tesm bryoloagnyd
textbooaknsd journal articlewse. haTvhee redfeovreel,op meinsdt e scribienCd h apte1r1 T.h ilse adtso
composetdh itse xtboionk o rdert oc ollatthea t ad escripotfit ohnea ge-chanogfte hsel umbasrp inien
materiwahli chw e considfeurn damenttaolt he Chapte1r2 T.h et hemed eveloptehdr ougChh apters
understanodfit nhegs tructfuurnec,t iaonndc ommon 11a nd1 2i st hatth el umbasrp inies n ota constant
disordoefrt sh el umbasrp ine. stereotyspterdu ctuarsed escribiendc onventional
We see thet exats o new hkh canb eused asa textboobkusto, net hacto ntinuaclhlayn geisnf orm
companitonoo thetre xtbooiknsi ntroductcooruyr ses andf unctiocnaapla citthyr ougholuitfA en.y concept
ina natomayn,d w hichc ana lsroe maians a resourceo fn ormalimtuys tb em odifiaecdc orditnotg h ea geo f
througholuatt eyre arso f undergraduaatned thep atieonrts ubject.
postgraduaetdeu catioinn physiotheraanpdy Thef inatl\v oc hapteprrso vidae b ridgbee tw(.-'(!n
phy&icmaeld icinIent. h irse garrde,f erenacreems a de basiacn atomayn dt hec linipcraolb leomf l umbar
throughotuhte t extt o contemporaarnyd major pains yndromeCsh.a pte1r3 o utlintehse p ossible
earlireers earpcahp ersso t hat the mraeyac doenrs ultm echanismosf lumbarp aini n termso f the
theo riginlailt eratuuproen whichd escriptioinnsn,e rvatoifto hne l umbasrp inaen dt her elatioofn s
interpretilantdip oonis. nts thel umbasrp inanle rveasn dn ervreo ots, thereby ofv iewa rcb aseMdo.r eover,
ther eferenchea sbl eiesntm adee xtensiinvo er detro providinagn anatomical founfdoart tihoen
provisdteu densetesk intgo u ndertarkees eaprrcohj ectasp preciaotfip oant hological ctohnadctia tnci aounsse
on somea specotft hel umbasrp inwei tha suitables pinpaali n.
startpionLgn itnt heseiarr cht hroutghhe l iterature. Chapte1r4 deals wpiatthh ologiacnaalt om. y
Chapte1r--s4o u tlitnhees tructoufrt eh ei ndividuaTlr adititoonpaillc isk ceo ngenidtiaslo rdefrrsa,c tures,
componenotfts h el umbasrp inaen,d t hei ntascpti ne dislocatainodnt su mourasr en otc overeadl,t hough
Description:A foundation textbook for those requiring an understanding of the structure and biomechanics of the lumbar spine and sacrum. The book aims to bring together in one source all of the elements of anatomy and biomechanics which are clinically relevant to the study of lumbar spinal pain. The text has be
