During my first eight years of practice, I did not think in terms of structural versus non-structural sources of pain.  A structural lesion is an injury that a) is distinctly identifiable on a test, such as a ruptured disc or pinched nerve, and b) matches the patients pain symptoms. You need both. If the test shows a pinched nerve and your symptoms aren’t known to be associated with that injury, something’s off.

Most patients I see have abnormalities in many places throughout the spine.  These are normal findings as people age.  Discs degenerate, collapse, form bone spurs, and can narrow the different parts of the spinal canal.  It is only when the clinical symptoms match the anatomy that we have a structural problem.

For example, the 5^th lumbar nerve root travels down the side of the leg.  If there is a herniated disc and/or bone spur pushing on that nerve, you may have symptoms down the whole side of your leg into your big toe.  Often just part of the L5 path of pain is painful.  It is common for the pain to be in the side of the calf.  Just pain in the buttock may the only symptom.  The pain just has to be somewhere in the path of that nerve.

I had a ruptured disc in my back pinching my left 5^th nerve root.  I had pain only in my big toe.  I had absolutely no back pain or leg pain.

If the pain is in the other leg or down the front of the leg, there is a different problem, because the pain does not match that particular pinched nerve root.

BF