I wish to consider a condition equally as important as arthritis of the spine or sacro-iliac subluxation, although it is not so common. It is a condition more common than is generally supposed, and equally as potent a factor in the causation of sciatica, scoliosis and painful back. I refer to a class in which, in the past, operation has been performed for various supposed pelvic and abdominal conditions, also for cord tumors and Pott's disease, or they have been treated medically for lumbago, rheumatism and sciatica without relief.
The cause of pain and disability in these cases is an anatomic variation in the shape or size of the transverse process of the fifth lumbar vertebra, sometimes spoken of as the lumbar rib. A study of the roentgenograms of the lumbar and pelvic region shows that variation in the size and shape of the lumbar process occurs as frequently as
SHACKLETON WE. SOME OF THE SURGICAL ASPECTS OF PAINFUL BACK. JAMA. 1916;LXVI(21):1600–1602. doi:10.1001/jama.1916.02580470010005
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