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Pain Distributions

Endoscopically Determined Pain Distributions

Referred pain is considered to follow dermatomal patterns. Aware state endoscopy demonstrates multiple overlap in the distribution pattern of referred pain. The exiting nerve at L5/S1often produces pain in the shin, heel and outer border of the foot. The traditional L5 distribution of pain may be present or absent. Here is a digest of the findings noted during Spinal Probing and Discography and confirmed during endoscopy to arise from the nerve and not the facet joint. Endoscopic findings suggest that much of the pain conceived to arise from the facet joints actually arises from the nerve in front of the facet joint. Steroid injections in to the facet joint may work by reducing the spasm around the joint and nipping of the nerve or by direct irrigation on to the nerve.

Endoscopically confirmed findings from probing exiting lumbar nerves at each level
Segmental level probed	Conventional Dermatomal symptoms	Exiting nerve	Displacement of the exiting nerve produces various combinations of:
L5/S1	“S1 Symptoms”, producing posterior thigh, calf, heel & lateral border of foot pain, parasthesiae, numbness and weakness of plantarflexion.	L5	“L5” symptoms: ± symptoms over the sacrum, medial buttock, lateral groin, Piriformis spasm. Pain over the L5/S1 facet joint and Sacroiliac joint and inferior lumbosacral paravertebral muscle spasm. ± occasional S1 symptoms (posterior thigh, calf, heel & lateral border of foot pain.
L4/5	“L5 symptoms”, producing posterolateral / anterior thigh, shin, lateral malleolus/ anterior ankle, dorsum of foot & great toe pain, parasthesiae, numbness and weakness of dorsiflexion.	L4	“L4” symptoms: ± symptoms over the sacrum, medial/lateral buttock, medial groin, greater trochanter, anterolateral thigh, ± Piriformis spasm / iliac crest related pain & paravertebral pain. ± occasional L5 symptoms ± occasional L3 symptoms in the anterior thigh
L3/4	“L4 symptoms”, anterior thigh, anterior knee, shin & instep pain, parasthesiae, numbness and weakness of knee extension or calf flexion.	L3	“L3” symptoms: ± symptoms over the lateral buttock, greater trochanter, iliac crest related pain, anterolateral thigh, anterior knee & paravertebral pain . ± occasional L2 & L4 symptoms
L2/3	“L3 symptoms”, lateral groin, hypogastric / iliac fossa discomfort, parasthesiae, numbness and weakness of hamstrings and hip flexion.	L2	“L2” symptoms ± symptoms over the sacrum, iliac crest, lateral groin, proximal anterior thigh & paravertebral pain . Deep anterior abdominal pain or symptoms. ± occasional L3 symptoms
L1/2	“L2 symptoms”, anterior groin and iliac fossa pain & proximal anterior and anteromedial thigh discomfort, parasthesiae, numbness and weakness of hip flexion and adduction..	L1	“L1” symptoms of hypogastric, iliac fossa pain: Deep anterior abdominal & Periumbilical pain & paravertebral pain. ± occasional L2 symptoms or T12 symptoms of upper abdominal discomfort

Cervical Symptoms distribution during anterior cervical probing and discography will be added in diagramatic form.

Anterior probing of cervical structures including the Longus Colli and the disc wall caused the following symptoms with implications regarding future treatment and the importance of minimal invasive surgery and postural retraining with muscle balance physiotherapy.

Probing of the anterior cervical structures such as the Longus Colli and the anterior Disc Wall. These findings have implications for the use of minimal invasive spine surgery and muscle balance physiotherapy and postural retraining.

The discography findings differ from the responses occasioned by probing the anterior structures.

High intensity zones can produce extremely disabling and bizarre symptoms mimicking regional reflex dystrophy, neuropathic pain to severe neck and arm pain. The pattern depends upon the direction of flow of the noxious disc contents.

Findings following Whiplash

Spinal Probing and Discography has an important medico-legal role as many patients who are considered to be malingerers are in fact shown by aware state examination to be completely genuine and surprisingly disabled on the basis of their MRI scans.