Kozera Katarzyna, Ciszek Bogdan, Szaro Paweł
Warszawski Uniwersytet Medyczny, Warszawa / Medical University of Warsaw / Zakład Anatomii Prawidłowej i Klinicznej Centrum Biostruktury / Division of Normal and Clinical Anatomy, Centre for Biostructure Research.
Szpital Dziecięcy im.Prof. J. Bogdanowicza, Warszawa / Prof. J. Bogdanowicz Paediatric Hospital, Warsaw / Oddział Neurochirurgii / Neursurgery Department.
Ortop Traumatol Rehabil. 2017 Aug 31;19(4):315-321. doi: 10.5604/01.3001.0010.4611.
Spinal Dorsal Ramus Mediated Back Pain is the second most frequently described condition (the first one being Lumbar Facet Syndrome) originating from pathology involving posterior branches of lumbar spinal nerves. Spinal Dorsal Ramus Mediated Back Pain was described as "thoracolumbar junction syndrome" by Maigne in 1989. As a rule, Spinal Dorsal Ramus Mediated Back Pain presents unilaterally within posterior branches at the levels Th11-12 and L1-2. The pain is triggered by extension and/or rotation. Typical symptoms include pain that may radiate towards the gluteal area and posterior iliac crest and does not cross the body midline. Clinical symptoms may correlate with the area supplied by the whole spinal nerve of the given segment, including both the posterior and anterior branch. For this reason, patients may report not only low back pain, but also pseudovisceral pain in the hypogastric area, false sciatic neuralgia, tenderness of the pubic symphysis and hypersensitivity of the intestines. The above symptoms may lead to diagnostic difficulties. Diagnostic work-up may benefit from performance of the Kibler Fold Test to determine sensitivity of the tissues surrounding the iliac crest. Patients with Spinal Dorsal Ramus Mediated Back Pain respond well to manual manipulative techniques if these are delivered in a technically correct manner and address the appropriate segment. A recommended approach for patients with absolute contraindications to manipulation, i.e. advanced osteoporosis or osteogenesis imperfecta, is a block of the po-sterior branch of the spinal nerve involved.
脊神经后支介导的背痛是第二常见的病症（最常见的是腰椎小关节综合征），源于涉及腰脊神经后支的病理状况。1989年，马尼将脊神经后支介导的背痛描述为“胸腰段交界综合征”。通常，脊神经后支介导的背痛单侧出现在胸11至12和腰1至2节段的后支内。疼痛由伸展和/或旋转引发。典型症状包括可能向臀区和髂后嵴放射且不越过身体中线的疼痛。临床症状可能与给定节段整个脊神经所支配的区域相关，包括后支和前支。因此，患者不仅可能报告下背痛，还可能报告下腹区的假性内脏痛、假性坐骨神经痛、耻骨联合压痛和肠道过敏。上述症状可能导致诊断困难。进行基布勒褶皱试验以确定髂嵴周围组织的敏感性，有助于诊断检查。如果以技术上正确的方式并针对适当节段进行手法治疗，脊神经后支介导的背痛患者对手法治疗反应良好。对于手法治疗有绝对禁忌证（即严重骨质疏松或成骨不全）的患者，推荐的方法是对受累脊神经后支进行阻滞。
