Priority; an unstable injury of the spine; conservative treatment; bed rest; exercise; physical modalities; manual therapy; medications; injections; epidural injection; nerve root block; operations; fusion; laminectomy; spinal instrumentation.

64 The medico-legal consultation- in general

Conduct of doctor; observation; symptoms and signs; pain; where is the pain? when does it hurt? what makes the pain worse? illness behaviour; the Waddell symptoms.

65 The patient's history

The accident; immediately after the accident; medical records; previous history; post accident supervening illness; doctor's manner; patient's manner.

66 Physical examination

Aims; the Waddell signs; movement; reversed lumbar-pelvic rhythm; instability catch; examination on couch; a neurological examination; SLR; the sciatic stretch test; the knee jerk; the ankle jerk; the femoral stretch test; palpation; muscle bulk; range of movement.

67 The report

The diagnosis; causation; the prognosis; advice on acceleration.

57 Functional anatomy of the thoraco-lumbar spine

57.1 Three joint complex The vertebrae, the building blocks of the spinal column, are connected together by three main joints: the intervertebral disc in front and a pair of facet (zygapophyseal) joints, one on either side, behind.

57.2 The pair of facet joints (see chapter 6) are synovial joints, so called because they contain lubricating synovial fluid lined by a synovial membrane. The main function of the facet joints is to control range and direction of movements between the vertebrae. By way of controlling movements they offer stability to the spine. Their excision (surgical removal) on one or either side may lead to spinal instability resulting in back pain with a typical instability catch. The facet joint