Non-structural pathology is defined as findings that are based on the following:

  • Possibly or probably normal for the patient’s age and activity
  • Based solely on a subjective test (interpretation of your reponse to a painful stimulus)
  • Non-progressive spinal deformities
  • Clinical picture is vague and there is not a definite match of pain to the pathology.
  • Examples are:
    • Dehydrated discs on MRI-just means there is less water and stiffer
    • Facet pain based just on facet blocks
    • Discogenic pain based on discography (not a valid test)
    • Old compression fractures that have healed
    • Stable degenerative spondylolithesis with just back pain
    • Stable isthmic spondylolithesis with just back pain
    • Non-progressive degenerative or idiopathic scoliosis
    • Right now this is a suggested starting point.  There is legitimate debate on many of these diagnoses regarding whether they are structural or not.  The ones I feel are the most up for debate are:
      • Degenerated discs with Modic changes (bony reaction)
      • Non-progressive degenerative scoliosis—the absolute number of degrees that a scoliotic curve should be fused for pain is not defined.