Lower Back Pain: Symptoms, Diagnosis, and Treatment

August 16, 2019 by bpadmin0

Low Back Pain:

Over 80% of the population will suffer from lower back pain during their lives. Although low back pain can be quite debilitating and painful, in about 90 percent of all cases, pain improves without surgery. However, 50 percent of all patients who suffer from an episode of low back pain will have a recurrent episode within one year.

Lumbar Spine:

The lumbar spine (lower back) consists of five vertebrae in the lower part of the spine between the ribs and the pelvis. The bones (vertebrae) that form the spine in the back are cushioned by small discs. These discs are round and flat, with a tough, outer layer (annulus) that surrounds a jellylike material called the nucleus. Located between each of the vertebrae in the spinal column, discs act as shock absorbents for the spinal bones. Thick ligaments attached to the vertebrae hold the pulpy disc material in place. Of the 31 pairs of spinal nerves and roots, five lumbar (L1-L5) and five sacral (S1-S5) nerve pairs connect beginning in the area of the lower back.

Common Causes of Low Back Pain:

1). Herniated disc:

The bones (vertebrae) that form the spine in the back are cushioned by small discs. Located between each of the vertebrae in the spinal column, these discs act as shock absorbents for the spinal bones preventing the bony vertebrae from grinding against one another. With age, these cushioning discs gradually wear away and shrink, a condition known as degenerative disc disease. The rubbery discs that lie between the vertebrae in the spine consist of a soft center (nucleus) surrounded by a tougher exterior (annulus). A herniated disc occurs when a portion of the nucleus pushes through a crack in the annulus. A herniated disc (also called a bulged, slipped or ruptured) disc.

A herniated disc in the lower back can put pressure on the nerve that extends down the spinal column. This commonly causes pain to radiate to the buttocks and all the way down the leg. This condition is called sciatica.

2). Osteoarthritis:

It is the most common type of arthritis and affects middle-aged or older people most frequently. It can cause a breakdown of cartilage in joints and occur in almost any joint in the body. It most commonly affects the hips, knees, hands, lower back and neck. Cartilage is a firm, rubbery material that covers the ends of bones in normal joints. It serves as a kind of “shock absorber,” helping to reduce friction in the joints. When osteoarthritis affects the spine, it is known as spondylosis.

3). Spondylosis :

 It is a degenerative disorder that can cause loss of normal spinal structure and function. Although aging is the primary cause, the location and rate of degeneration vary per person. Spondylosis can affect the cervical, thoracic and/or lumbar regions of the spine, with the involvement of the intervertebral discs and facet joints. This can lead to disc degeneration, bone spurs, pinched nerves and an enlargement or overgrowth of bone that narrows the central and nerve root canals, causing impaired function and pain.

When spondylosis affects the lumbar spine, several vertebrae usually are involved. Because the lumbar spine carries most of the body’s weight, activity or periods of inactivity can both trigger symptoms. Specific movements, sitting for prolonged periods of time and lifting and bending all may increase pain. When spondylosis worsens, a patient may develop spinal stenosis.

4). Lumbar Spinal Stenosis:

It is narrowing of the spinal canal, compressing the nerves traveling through the lower back into the legs. If the narrowing is substantial, it causes compression of the spinal cord or spinal nerves, which causes the painful symptoms of lumbar spinal stenosis, including low back pain, buttock pain, and leg pain and numbness that is made worse with walking and relieved by resting. While it may affect younger patients, due to developmental causes, it is more often a degenerative condition that affects people who are typically age 60 and older.

5). Degenerative spondylolisthesis:

Slippage of one vertebra over another is caused by osteoarthritis of the facet joints. Most commonly, it involves the L4 slipping over the L5 vertebra.

6). Degenerative scoliosis:

It occurs most frequently in the lower back and more commonly affects people aged 65 and older. Back pain associated with degenerative scoliosis usually begins gradually and is linked with activity. The curvature of the spine in this form of scoliosis is often relatively minor. Surgery may be indicated when nonsurgical measures fail to improve pain associated with the condition.

Vertebral fractures. Usually caused by osteoporosis (brittle bones)

Diagnosing Low Back Pain:

Diagnosis is made based on history, symptoms, a physical examination and the results of diagnostic studies if required. Some patients may be treated conservatively and then undergo imaging studies if medication and physical therapy are ineffective. Tests used to help confirm the causes of back pain include:

  • X-rays
  • Magnetic Resonance Imaging (MRI)
  • Computerized axial tomography (CAT) scan or CT scan
  • Bone scan
  • Bone density test
  • Nerve Conduction Studies (NCS)

Lower Back Pain Treatment Options

1). Non-Surgical (Conservative):-

It includes physical therapy, back exercises, weight reduction, steroid injections (epidural steroids), non-steroidal anti-inflammatory medications, rehabilitation, and limited activity. It aims at relieving the inflammation in the back and irritation of nerve roots. Usually, four to six weeks of conservative therapy is advised before considering surgery.

Anti-inflammatory medications to reduce swelling and pain and analgesics to relieve pain. Most pain can be treated with nonprescription medications, but if the pain is severe or persistent, a doctor may recommend prescription medications.

Epidural injections may be prescribed to help reduce swelling. This treatment is not recommended repeatedly and usually, provides only temporary pain relief.

Physical therapy and/or prescribed exercises may help stabilize the spine, build endurance and increase flexibility. Therapy may help with the resumption of normal lifestyle and activities. Yoga may be effective for some people in helping to manage symptoms.

Maintaining a proper weight is crucial to the effective management of osteoarthritis. Being overweight is a risk factor for osteoarthritis. Practice good posture when sitting or standing. When lifting something, lift with the knees, not with the back.

Smoking — the bad habit that increases the risk of dozens of diseases — can also lead to backaches. Get help to kick the habit of smoking.

2). Surgical:-

When conservative treatment for low back pain does not provide relief, surgery may be needed. One may be a candidate for surgery if:

  • Back and leg pain limits normal activity or impairs quality of life
  • Progressive neurological deficits develop, such as leg weakness and/or numbness
  • Loss of normal bowel and bladder functions
  • Difficulty standing or walking
  • Medication and physical therapy are ineffective
  • The patient is in reasonably good health

Following are some of the procedures for treating low back pain:

  • A discectomy relieves pressure from a nerve root pressed on by a bulging disc or bone spur. In this procedure, a small piece of the lamina, a bony part of the spinal canal is removed.
  • A foraminotomy is a surgical procedure that opens up the foreman, the bony hole in the spinal canal where the nerve root exits.
  • Radiofrequency lesioning or ablation is a way to use radio waves to interrupt the way the nerves communicate with each other. A special needle is inserted into the nerves and heats it, which destroys the nerves.
  • Spinal fusion makes the spine stronger and cuts down on painful motion. The procedure removes discs between two or more of the vertebrae and then fuses the vertebrae next to each other with bone grafts or special metal screws.
  • A spinal laminectomy, also known as spinal decompression, removes the lamina to make the size of the spinal canal bigger. This relieves pressure on the spinal cord and nerves.

How To Prevent Low Back Pain:

There are many ways to prevent low back pain. Practicing prevention techniques may also help lessen the severity of the symptoms of a lower back injury. Prevention involves exercising the muscles in the abdomen and back, losing weight in case overweight, lifting items properly (bending at the knees and lifting with the legs), and maintaining proper posture.

Sleep on a firm surface and sit on supportive chairs that are at the correct height. Avoid high-heeled shoes. Quit smoking – nicotine causes degeneration of spinal discs and also reduces blood flow.

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Lower Back Pain: Symptoms, Diagnosis, and Treatment 1

About Dr. Arun Saroha

Dr.Arun Saroha is working as Neurosurgeon with a special interest in spine surgery for the last 15 years. He specializes in Neuro-oncology, Paediatric Neurosurgery, Neurotrauma, Stroke & Cerebrovascular surgery including Transnasal surgeries. He has also been performing instrumented/ Non-instrumentation spine surgeries, including minimally invasive spine surgeries. He has performed more than 6,000 Neurosurgeries (Spine and Brain) successfully till date with patients from all over the world.


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