As part of the Oryon Academy Spinal Symposium 2026, Consultant Spine Surgeon Mr Caspar Aylott delivered an engaging session exploring spinal biomechanics, diagnostic challenges and the importance of combining imaging findings with thorough clinical assessment.
Drawing on real-world case studies, Mr Aylott highlighted how patients with spinal symptoms are often given multiple explanations for their pain, and why achieving the correct diagnosis can sometimes be more complex than it first appears.
The Challenge of Diagnosis
Patients with back and leg pain often arrive having received a variety of different diagnoses and treatment recommendations.
Spinal symptoms can originate from several different structures, including intervertebral discs, facet joints, sacroiliac joints, nerves, hips and surrounding soft tissues. While modern imaging plays an important role in diagnosis, Mr Aylott emphasised that imaging should always be interpreted within the context of the patient’s symptoms and examination findings.
As he reminded attendees:
“At a time of ever more sophisticated imaging, the art of history taking and examination remains as important as ever.”
Looking Beyond the Obvious
One of the key themes from the session was the importance of maintaining an open mind.
Through a series of clinical case studies, Mr Aylott demonstrated how symptoms that appear to originate from the spine can sometimes have a completely different cause.
In one example, a patient with longstanding back and leg pain had undergone multiple spinal assessments and treatments before a detailed examination identified significant hip pathology as the primary issue. Following appropriate treatment, the patient’s symptoms improved dramatically.
The lesson was clear: accurate diagnosis requires clinicians to consider the whole patient, not just the scan.
Understanding Biomechanics
Mr Aylott also explored how variations in spinal anatomy can influence biomechanics and contribute to pain.
Conditions such as Bertolotti Syndrome and transitional lumbosacral anatomy can alter the way forces are distributed through the spine, potentially leading to degeneration and symptoms at adjacent levels.
Understanding these biomechanical factors can be essential when assessing patients with persistent or unexplained symptoms.
Imaging as Part of the Clinical Picture
AThroughout the session, imaging remained a central theme.
An MRI scan provides exceptional detail and can identify a wide range of spinal conditions. However, as Mr Aylott demonstrated through several examples, imaging findings alone do not always tell the full story.
Clinical judgement, patient history and examination remain critical in determining which findings are relevant and how they should influence treatment decisions.
Perhaps the most memorable takeaway from the session was the reminder that clinicians are:
“Treating people, not scans.”
About Mr Caspar Aylott
Mr Caspar Aylott is a Consultant Spine Surgeon with specialist interests in spinal biomechanics, complex spinal diagnosis, adult spinal deformity, stenosis and motion-preserving spinal technologies.
A dual-qualified engineer and surgeon, he combines extensive clinical expertise with a deep understanding of spinal mechanics to support patient diagnosis and management.
View Mr Aylott’s Practitioner Finder profile to learn more about his areas of expertise and how he supports patients and referrers.
Watch the Recording
The full recording of Spinal Problems, Biomechanics and a Few Surprises is now available on demand through Oryon Academy.
Watch the session to explore the clinical cases, diagnostic challenges and practical insights discussed during the symposium.
