Low Back Pain

Overview

Low back pain is not unique. An estimated 75-85% of Americans experience some form of back pain during their life. Although low back pain can be quite debilitating and painful, in approximately 90% of cases, it is temporary and pain improves without surgery. However, 50% of patients who suffer from episodes of low back pain will have recurrent episodes within one year. Low back pain is considered to be chronic when it persists for more than 12 weeks.

The Lumbar Spine

The lumbar spine (lower back) consists of five vertebrae (bones) in the lower part of the spine between the ribs and the pelvis. The vertebrae that form the spine in the back are cushioned by small discs, which are located between each of the vertebrae and act as shock absorbers for the spinal bones. These discs are round and flat, with a tough, outer layer (annulus) that surrounds a jelly-like material called the nucleus. 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 lower back area.

Common Causes of Low Back Pain

• Sprains & Strains
• Traumatic Injury
• Fracture
• Herniated Disc
• Sciatica
• Lumbar Spinal Stenosis
• Osteoarthritis
• Scoliosis

SYMPTOMS + TYPES

The symptoms of low back pain show up as pain in the low back that can include pain that goes into the glutes (buttocks), hips or legs. The pain can be sharp, dull, aching, burning or a combination of all of these. It can be constant, intermittent or activity-related.

TESTING + DIAGNOSIS

Although low back pain is a common occurrence, some features warrant evaluation from a medical professional, such as persistent or worsening back pain; neurologic symptoms, including numbness, weakness, or tingling; or changes in bowel or bladder function.

Diagnosing Low Back Pain

Diagnosis is made by a neurosurgeon based on history, symptoms, physical examination and results of diagnostic studies. Some patients may be treated conservatively; if conservative treatment is ineffective, the physician may order imaging studies of the lower back and other tests, which may include:

• Computed Tomography Scan (CT or CAT scan)
• Discography
• Electromyography (EMG)
• Nerve Conduction Studies (NCS)
• Magnetic Resonance Imaging (MRI)
• Myelogram
• Selective Nerve Root Block
• X-rays

TREATMENT + CARE

Treatment options include physical therapy, back exercises, weight reduction, steroid injections (epidural steroids), nonsteroidal anti-inflammatory medications, acupuncture, rehabilitation and limited activity. All of these treatment options are aimed at relieving inflammation in the back and irritation of nerve roots. Physicians usually recommend four to six weeks of conservative therapy before considering surgery.

If low back pain occurs after a recent injury — such as a car accident, a fall or sports injury — call your primary care physician immediately. If you have any neurologic symptoms (numbness, weakness, tingling or bowel and bladder dysfunction), seek medical care immediately. If no neurologic problems are present, the patient may benefit by beginning conservative treatment at home for two to three weeks. The physician may recommend anti-inflammatory medications, such as aspirin or ibuprofen, and restrict strenuous activities for a few days.

If low back pain worsens or does not improve after two to three weeks of home treatment, contact the primary care physician. The physician can evaluate and perform an in-office neurologic exam to determine which nerve root is being irritated and to rule out other serious medical conditions. If the physician notes clear signs that the nerve root is being compressed, he/she can prescribe medications to relieve the pain, swelling and irritation. In addition, the doctor may recommend that limiting activities, provide a referral to a pain management specialist or both. If these treatment options do not provide relief within a few weeks, it may be time to consider other diagnostic studies and possibly surgical evaluation.

When Surgery is Necessary

When conservative treatment for low back pain does not provide relief or neurologic symptoms are worsening or severe, surgery may be needed. Candidates for surgery present any of the following:

• Reasonably good health
• Back and leg pain limits normal activity or impairs quality of life
• Progressive neurologic deficits develop, such as leg weakness, numbness or both
• Loss of normal bowel and bladder functions
• Difficulty standing or walking
• Medication and physical therapy are ineffective

If surgery is recommended, neurosurgeons have a variety of options available to help relieve pressure on the nerve roots. If several nerve roots and discs are causing the pain or if degeneration and instability exist in the spinal column, the neurosurgeon may choose: (1) a minimally invasive approach; (2) a more open decompression; or (3) fusing the vertebrae together with bone grafts and stabilizing them with instrumentation, including metal plates, screws, rods and cages, depending on the extent of disease. After such surgery, patients may gain restored mobility in the back, including the ability to bend over. In addition, patients may require postoperative physical therapy.

The benefits of surgery should always be weighed carefully against the risks. Although a large percentage of patients with low back pain report significant pain relief after surgery, it is not guaranteed that surgery will help.

PREVENT + MANAGE

If back pain resolves with non-surgical, conservative treatment, follow-up will likely be on an as-needed basis or if symptoms return. If a patient undergoes surgery, follow-up is different for each type of procedure.