Zur Kenntnis der Ätiologie und Pathogenese der Lumbago und änlicher Rückenschmerzen.
Authors: LINDSTEDT FOLKE 
Published: August 2010

Resumé.

The writer proceeds from the results of his previous investigations of sciatica. (Acta medica scand. Vol. LIII Fasc. III. 1920.). According to these researches a great number of heterogeneous peripheric pathologic changes, localized to the lower extremities, the back or the pelvis, are of ætiological importance as regards the origin of sciatica. This disease is regarded by the author as an irradiating or reflected neuralgia, thus being always secondary to stimuli from the peripheric nervous system.

The writer also shows, how in patients suffering from sciatica, lumbago‐symptoms not only frequently occur as partial symptoms of sciatica, but also in its anamnesis in form of isolated symptoms. He declares this form of lumbago (in sciatica‐patients) to be of the same neuralgic nature and to have the same causes of disease as sciatica itself. — The relations between sciatica and lumbago is illustrated by an analysis of the function of the lumbar musculature, this function being intimately connected with the action of the muscles of the lower limbs whilst walking. That is to say, the writer considers, that both sciatica and lumbago, in conformity with certain other neuralgic symptoms (compare professional neuralgias and static pains), can be caused by muscular hyperfunction.

The writer further tries to investigate how far even other forms of lumbago (in non‐sciatica‐patients) may be in causal connection with such peripheric changes, as may be regarded of ætiological importance as regards the origin of sciatica. For this purpose he has examined a material of 1578 conscripts. This material was distributed into 3 groups, and marked as follows: »more severe» (group I), »easier» (group II) or »no changes» (group III); the writer having whenever opportunity offered itself taken an objectiv point of view, and where not, he did rely on anamnesis.

The pathologic changes and diseases here considered consisted of: 1) Affections of the back, 2) the pelvis and its surroundings, 3) Affections of the hipjoint and the femur, 4) Affections of the knee‐joint, 5–7) Genu valgum, varum and recurvatum, 8) Injuries of the foot, 9) Flat foot, 10) Anomalies of the foot, 11) Polyarthritis, 12) Varices, 13) »Static weakness», 14) Fracture of the lower legs, and 15) Certain other affections.

The author finds, that among 318 cases belonging to group I, 78 cases had suffered from »lumbago», whereas among 864 cases belonging to group III, only 15 cases of »lumbago» were stated. (Among the remaining 396 cases, group II, there were 24 cases of »lumbago».) Hence the writer concludes, that in many of his cases of »lumbago» the changes, that had been pointed out, must have been of ætiological importance for the origin of lumbago. Also several other circumstances (localization of the symptoms etc.) as well as 17 related histories of disease are arguing in favour of the probability of this conclusion.

The examined material, including also 14 cases of sciatica, seems even to a higher degree to bear out the author's previously expressed opinion, that those changes are of ætiological importance also as regards the origin of sciatica.

Upon this the writer relates 10 histories of disease of so‐called equivalent‐cases, showing certain less prononuced neuralgic or »rheumatic muscular» symptoms in the lumbar region or in the »sciatic region» or in both these regions simultaneously. These symptoms, also seeming to be causal connected with changes of the said kind, are regarded by him as abortive lumbago‐respectively sciatic symptoms. The ætiological function of the change being unilateral, these »equivalent symptoms» are — in analogy with the more typical sciatic and lumbago symptoms — as a rule unilateral, and localized to the same side as the change.

The writer is particularly calling attention to the fact, that for the origin of lumbago as well as of sciatica, peripheric changes and diseases can be of ætiological importance even when the changes in question only can be pointed out in the anamnesis.

Finally the writer is propounding a theory of the ætiology and the pathogenesis of lumbago. This theory, in essential parts, agrees with his previous statements concerning sciatica. His point of view regarding lumbago may briefly be summarized as follows:

Lumbago is to be regarded as an irradiating or reflected neuralgia. Thus a great number of different forms of peripheric stimulations, being of such a nature and localization, that an irradation of pain in the lumbar region can be provoked, may be of œtiological importance for the origin of the neuralgia.

The neuralgic pain reaction in question however, usually more or less pathologic in regard to the peripheric stimulation, seems as a rule to imply a »neuralgic disposition» for its origin, that is a state of general hypersensibility in the central nervous system. Here the constitutional neurosis seems especially to be of importance. But other momenta too may from the same point of view act œtiologically, such as psychic depression, infection, intoxication, cachexias, meteorological influences and so forth.

The localization of neuralgia to the lumbar region is determined by the peripheric stimulation. The causes of the peripheric stimulus might in most cases of lumbago be pointed out objectively or anamnestically. They might consist of all kinds of injuries (trauma, coldness etc.), or of active pathologic changes in the spine or in the soft parts of the lumbar region (spondylitis, muscular rupture etc.) or possibly in certain visceral organs (renal deseases etc.). Of greater importance, however, seem to be all momenta, that somehow lead to hyperfunction of the muscular system of the lumbar region. Thus a great number of different anomalies, deformities, anchylosing processes, painful lesions or certain other states of disease (obesitas, muscular weakness etc.), which are followed by disorders in the muscular function brought on by walking and standing, may be able to provoke lumbago. The changes acting œtiologically in this way may be localized not only to the lumbar region, but also to other parts of the back, as well as to the lower extremities of or the pelvis, or the annexed organs.

Sciatica and lumbago, as well as certain other neuralgic or 80 called rheumatic muscular symptoms in these regions are from a pathogenetic and even from an œtiological point of view to be regarded as equivalent neuralgic diseases.