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Yellow flag signs are psychological factors shown to be indicative of long-term chronicity and disability. Postural syndrome: due to a mechanical deformation of normal soft tissue from prolonged end range loading of periarticular structures (static deformation of spine). Pain may be local and reproducible when end range positions, such as slouching, are maintained for sustained periods of time. Dysfunction syndrome: due to adaptive shortening, scarring or adherence of connective tissue causing discomfort. May show one direction of repeated movement which decreases or centralizes referred symptoms – preferred direction. Disc origin pain is aggravated by flexion and has a gradual onset while, the facet origin pain is aggravated by extension and has a more sudden onset.
The lumbar spine is a stack of bony vertebrae with round discs between them like shock absorbers.
An epidural injection allows for a small dose of steroid to be placed directly at the inflamed area. If you have an allergy to steroids, anesthetics, xray contrast, or iodine; let the nurse and radiologist right away.


The transforaminal approach is a selective injection to treat a specific nerve and adjacent dura (nerve covering). When the inflammation is more diffuse and multiple areas of nerves and dura are inflamed, an interlaminar approach may be preferred.
On the day of your injection, you should not have anything to eat or drink for at least two (2) hours before your scheduled procedure. You may notice some reduction in your pain within the first hour or two after the injection. McKenzie Institute® assessment forms to accurately record findings in the examination of the cervical spine.
Grant Support: In part by grants HS-08194 and HS-094990 from the Agency for Healthcare Research and Quality, a Veterans Affairs ERIC grant, and grant 1 P60 AR48093 from the National Institute of Arthritis and Musculoskeletal and Skin Diseases. Anyone can submit a comment any time after publication, but only those submitted within 4 weeks of an article’s publication will be considered for print publication. Straight Leg Raise: assesses the presence of radiculopathy – if pain is reproduced and radiates down into affected leg when the leg is raised between 10 and 60 degrees elevation.
Complete a thorough neurological exam, including gait, ankle reflex (S1), knee reflex (L4), strength, sensation (look for saddle anesthesia and anal sphincter tone, plus check dermatomes along lower limb).


Jarvik, MD, MPH, Department of Radiology, University of Washington, Box 357115, 1959 NE Pacific Sreet, Seattle, WA 98195. Deyo: Center for Cost and Outcomes Research, 146 North Canal Street, #300, Seattle, WA 98103. One month after publication, editors review all posted comments and select some for publication in the Letters section of the print version of Annals. For adults younger than 50 years of age with no signs or symptoms of systemic disease, symptomatic therapy without imaging is appropriate.
For patients 50 years of age and older or those whose findings suggest systemic disease, plain radiography and simple laboratory tests can almost completely rule out underlying systemic diseases.
Advanced imaging should be reserved for patients who are considering surgery or those in whom systemic disease is strongly suspected.



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