Low back pain is quite common, as an estimated 75-85% of Americans experience some form of back pain during their lifetime. Low back pain can be quite painful and debilitating, but in about 90% of its cases, low back pain is temporary, improving without surgery. Even so, about 50% of patients who suffer from low back pain episodes will have recurrent episodes within one year. When it lasts for over 12 weeks, low back pain is considered chronic.
THE LUMBAR SPINE
The lumbar spine (lower back) consists of five vertebrae in the lower part of the spine, ranging between the ribs and pelvis. The vertebrae that form the spine in the back are cushioned by small discs. Located between each vertebrae, these discs act as shock absorbers for each spinal bone. Round and flat, these discs have a tough, outer layer (annulus), which surrounds a jelly-like material (nucleus). The pulpy material is held in place by thick ligaments, which are attached to the vertebrae.
Of the 31 pairs of spinal nerves and roots, five lumbar (L1–L5) and five sacral (S1–S5) nerve pairs connect, beginning in this lower back area.
COMMON CAUSES OF LOW BACK PAIN
- Strains and sprains
- Traumatic Injury
- Fracture
- Herniated Disc
- Sciatica
- Lumbar Spinal Stenosis
- Osteoarthritis
- Scoliosis
SYMPTOMS
The symptoms of low back pain show up as pain in the low back. This includes pain that goes into the glutes (buttocks), hips or legs. The pain can be described as dull, sharp, aching, burning, or a combination of these sensations. It can be constant, intermittent or arising during certain activities.
WHEN TO SEEK MEDICAL HELP
Low back pain is a common problem, but some features warrant evaluation from a medical professional. These include persistent or worsening back pain; neurologic symptoms, including numbness, tingling, or weakness; or changes in bladder or bowel function.
DIAGNOSING LOW BACK PAIN
A neurosurgeon bases their diagnosis on symptoms, history, physical examination, and results of diagnostic studies.
Some patients may receive and benefit from conservative treatment. However, if conservative treatment is ineffective, the physician may order imaging studies of the lower back and other tests, such as:
- 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
NON-SURGICAL TREATMENT OPTIONS
Treatment options include weight reduction, physical therapy, limited activity, acupuncture, back exercises, steroid injections (epidural steroids), nonsteroidal anti-inflammatory medications, and rehabilitation. These are aimed at relieving inflammation located in the back and/or irritation of the nerve roots. Before considering surgery, physicians also usually recommend four to six weeks of conservative therapy.
If low back pain occurs after recent injury (a car accident, a fall, sports injury, etc), immediately call your primary care physician. If you suffer from neurologic symptoms (tingling, numbness, weakness, or bowel and bladder dysfunction), seek medical care immediately. If no neurologic problems present, the patient may benefit from undertaking conservative treatment at home for two to three weeks. The physician may recommend anti-inflammatory medications like aspirin or ibuprofen and restrict strenuous activities for a few days.
If low back pain worsens, or if it fails to improve after two to three weeks of at-home treatment, contact the primary care physician. The physician can evaluate and perform an in-office neurologic exam. This will determine the irritated nerve root, and it will rule out other serious medical conditions. If the physician notes distinct signs of the nerve root being compressed, the doctor may prescribe medications to relieve the patient’s pain, swelling, and irritation. Additionally, the doctor may recommend limiting activities, provide a referral to a pain management specialist, or do both. If these treatment options fail to provide relief after a few weeks, it may be necessary to consider other diagnostic studies and potentially surgical evaluation.
WHEN SURGERY IS NECESSARY
If conservative low back pain treatment does not provide pain relief or if neurologic symptoms are worsening or severe, surgery may be required.
Candidates for surgery present any of the following symptoms:
- Reasonably good health
- Back and leg pain limits normal activity or impairs quality of life
- Progressive neurologic deficits develop (leg weakness, numbness, or both)
- Loss of normal bladder and bowel functions
- Difficulty walking or standing
- Medication and physical therapy are ineffective
If surgery is recommended, neurosurgeons have a variety of options that can help relieve pressure on the nerve roots. If several nerve roots and discs are causing the pain or if instability and degeneration exist in the spinal column, the neurosurgeon may select:
- A minimally invasive approach
- A more open decompression
- Fusing the vertebrae together with bone grafts, stabilizing them with instrumentation (metal plates, rods, screws, and cages), depending on the extent of disease.
After such surgery, patients may have restored back mobility, including their ability to bend over. Also, a patient may need postoperative physical therapy.
The benefits of every surgery should always be weighed carefully against the surgery’s risks. Although a large percentage of lower back pain patients report significant pain relief after surgery, no guarantee can be provided that surgery will help every individual.
FOLLOW-UP
If back pain resolves with the help of conservative, non-surgical treatment, follow-up will most likely occur on an as-needed basis or if a patient’s symptoms return. Follow-up differs for each type of surgical procedure.
