ABSTRACT
Lumbar pain and sciatica are responsible for a significant portion of health care expenditure afflicting approximately 10 million individuals at an estimated cost of several billion dollars in diagnosis, treatment, and lost wages (1,2). A variety of spinal structures can serve as the source of incapacitating lumbar pain. However, the lumbar intervertebral disc has been demonstrated to be the most common cause of chronic low back pain (3). Lower limb pain in the presence of lumbar pain may be somatically referred from deep spinal structures (4) or may be the manifestation of nerve root insult (5). Intervertebral disc herniation has long been recognized as a common source of neural injury (6,7), and can present as lower limb pain with or without motor or sensory deficits (8). Radicular signs and symptoms are addressed in a therapeutically different fashion than axial discogenic symptomatology. These treatment measures have been molded by the prevailing theory of spinal pathophysiology.
