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indication of immediate MRI scan and surgical decompression of the cauda-equina, in terms of hours than days. Even more than a few hours delay may preclude any possible recovery of the loss of sphincter function.

⁴² Alexander RH and Proctor HJ (1993) ATLS student manual 5^th eds. American College of Surgeons, Committee on Trauma. Chicago, IL.

⁴³ White AA and Panjabi MM (1990) Clinical biomechanics of the lumbar spine 2^nd eds. Lippincott, Philadelphia p278 defined clinical instability as failure to maintain morphology (anatomical alignment of its structures) and neurology (status of any neurological deficit) under physiological load (normal activities of daily life).

⁴⁴ Essea SI and Reitman C (1995) Nonoperative care of the spine in Text book of Spinal Disorders. Lippincott. Philadelphia p145.

⁴⁵ osteophytes are small beads of new bones which form spontaneously around a degenerated joint from the margin of bone, in response to the degenerative process.

⁴⁶Greenough CG and Fraser RD (1994) Aetiology, diagnosis and treatment of low back pain. Eur Spine J 3:22.

⁴⁷ Greenough CG and Fraser RD (1994) Aetiology, diagnosis and treatment of low back pain. Eur Spine J 3:22.

⁴⁸ Greenough studied recovery from low back pain in 1-5 year follow-up of 287 injury-related cases using The Oswestry disability scale, The Waddell disability scale, The Waddell physical impairment rating and also a new scale – The low back outcome scale. They found that the diagnosis, type and severity of injury, migrant status and neurological deficits were not determinant factors for recovery from injury related low back pain. The compensation (particularly lump sum claims), psychological disturbances at review, time off work, and age at injury were important factors in recovery. Greenough CG (1993) Recovery from low back pain. 1-5 year follow-up of 287 injury-related cases. Acta Orthop Scand Suppl. 254:1-34 .

⁴⁹ Waddell G, McCulloch JA, Kummel E, Venner RM (1980) Nonorganic