Nearly 75-85% of Americans will have back pain sometime in their life. In 9/10 cases, back pain can improve with nonsurgical treatments and will not last forever. ½ of patients who get episodes of lower back pain may have episodes happen again within a year. If lower back pain lasts longer than 12 weeks it is a chronic condition.
THE LUMBAR SPINE
The lower back refers to the lumbar spine. This part of the spine has five vertebrae that are located between the ribs and the pelvis. Discs provide support to the vertebrae and work to absorb shock from the bones of the spine. These discs are flat and round with a tough outer layer and a soft core. There are thick ligaments that attach to the vertebrae to hold the disc material in place.
Five lumbar and five sacral nerve pairs connect starting the lower back region of the 31 pairs of spinal nerves and roots.
COMMON CAUSES
- Sprains or strains
- Traumatic injury
- Fracture
- Herniated disc
- Sciatica
- Lumbar spinal stenosis
- Osteoarthritis
- Scoliosis
SYMPTOMS
Symptoms include pain in the lower back that may radiate into the glutes, hips, or legs. The pain can be sharp, dull, burning, aching, constant, on and off, or related to certain activities.
SEEKING CARE
If back pain continues to get worse or if neurological symptoms arise or if there are bowel and bladder issues, consider seeking medical help.
DIAGNOSING LOWER BACK PAIN
A neurosurgeon will evaluate a patient by taking a history, looking at symptoms, taking a physical examination, and looking at images. Some patients can be treated very conservatively. If conservative treatments have not proven to be effective, some images and tests may be ordered that could include:
- CT or CAT scan
- Discography
- Electromyography (EMG)
- Nerve Conduction Studies (NRS)
- Magnetic Resonance Imaging (MRI)
- Myelogram
- Selective Nerve Root Block
- X-rays
NONSURGICAL TREATMENT
Some examples of nonsurgical treatment include physical therapy, exercises, maintaining a healthy weight, steroid injections, nonsteroidal anti-inflammatory medications, acupuncture, rehabilitation, or limited activity. Treatment has the goal to limit irritation of nerves and decrease inflammation. Before looking at surgery, at least six weeks of nonsurgical treatment should be considered.
If lower back pain arises after a traumatic accident or injury, speak with medical care immediately. If neurological symptoms, such as numbness, weakness, bowel or bladder issues, speak with medical care. If there are no neurological symptoms, a patient can try nonsurgical treatment options at home for multiple weeks before seeking care. Ibuprofen, aspirin, or other medications may be recommended and also it can be recommended to limit intense activities.
If lower back pain gets worse after multiple weeks of at home treatment, speak with a medical official. A physician can evaluate and examine a patient to determine what nerve root has been aggravated. If a nerve is being compressed, medication can be used to decrease pain, swelling, and inflammation. Limiting activities may be recommended. If these treatment options do not work after multiple weeks, it may be time to consider other tests or surgery.
SURGERY
If nonsurgical treatment does not decrease pain and symptoms, surgery could be needed. Surgery candidates should present:
- In good health
- Life impairing back pain
- Neurological deficits
- Bladder or bowel dysfunction
- Issues standing or moving
- Nonsurgical treatment has not worked
A neurosurgeon could take a minimally invasive approach, an open decompression, or a bone fusion as surgical options if nerve roots or discs are causing the pain. After surgery, patients may need therapy. There is never a guarantee that surgery will cure lower back pain.
