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Lower Back Pain

CONDITIONS

Lower Back Pain

  • It is estimated that 84% of adults have low back pain some time in their lives.
  • Most back pain episodes are self-limited and improve with conservative measures. 
  • Conservative treatment includes combination of physical therapy, medications, injections, and in some cases surgical interventions.
  • Risk factors associated with higher prevalence of low back pain include smoking, obesity, female gender, physically strenuous work, sedentary work, low educational attainment, worker’s compensation insurance, job dissatisfaction, and psychological factors such as somatization disorder, anxiety, and depression. 
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What Causes Back Pain?

  • Nonspecific back pain accounts for vast majority of patients which is generally attributed to musculoskeletal injury. Strains to the muscles and ligaments by heavy lifting, sitting, or standing for long periods of time, and sporting activities that require twisting of the lower back (like basketball, baseball, or golf) can all result in back pain. Certain factors like excess weight, weak abdominal muscles, and a forward-tilted pelvis can increase your risk of developing back pain.

 

  • Less than 10% of patients present with sciatica due to bulging and degenerative discs of the spine. This usually presents with low back pain radiating into legs/feet and can be associated with numbness/tingling/weakness/loss of reflex. Degenerative disc disease is a condition in which the shock-absorbing discs between your vertebrae slowly dry out, becoming thinner and more rigid. That might cause few if any symptoms at first but can lead to herniated discs and spinal stenosis (narrowing of the spinal column), which, in turn, causes painful radiculopathy (pinched nerves).

 

  • Lumbar spondylosis (osteoarthritis) is the type of arthritis that can be the cause of lower back pain. It is commonly an age-related condition, developing after years of wear-and-tear on your spine, which causes the facet joints that link your vertebrae to lose their protective cartilage. As a result, the bones start rubbing together, causing chronic inflammation and pain. You might also develop bone spurs – little bony growths in your facet joints that your body produces to support arthritic vertebrae. Bone spurs are another common cause of pinched nerves. Degenerative changes can also cause conditions like spondylolisthesis, in which weakened ligaments in your spine allow the vertebrae to slide over each other.

 

  • Spinal stenosis (narrowing) due to degenerative arthritis (also knowns as spondylosis and spondylolisthesis) affects patients more than 60 years of age. Symptoms are generally described as heavy, achy legs with burning sensation and gets worse with walking and improves with rest.

 

  • Sciatica refers to pain that is characterized by radiating pain from lower back and buttock region along the path of the sciatic nerve coursing through buttock/hips, down the leg up to the foot region. It is often characterized with other symptoms such as numbness, tingling and motor strength weakness. The most common condition that causes sciatica is a bulging disc in the lumbar region, also sometimes referred to as herniated disc that pinches the nerve resulting in swelling and inflammation of the nerve.

 

  • Other etiology includes sacroiliitis (buttock pain), scoliosis (abnormal curvature causing muscle pain), kyphosis (forward tilted posture), ankylosing spondylitis (auto immune disease), psychological stress (nonspecific pain throughout the body), piriformis syndrome (gluteal pain), Bertolotti’s syndrome (tailbone pain).

 

  • Less than 1% of patients will have a serious pathology such as cauda equina syndrome from spinal cord compression (loss of bladder or bowel function), metastatic cancer (multiple myeloma, colon cancer, breast cancer, prostate cancer), and spinal infection (abscess). 

 

  • Other medical non-spine related medical conditions such as pancreatitis, kidney stones, abdominal aortic aneurysm, shingles, uterine fibroids, etc.


How Is Back Pain Diagnosed?

  • The clinical evaluation of low back pain starts with history and physical to evaluate for signs and symptoms that indicated need for immediate imaging and further evaluation. 

 

  • A comprehensive history is important first step understanding the cause of back pain. It is further complimented with a focused physical examination. 

 

  • Learning more about previous episodes of similar presentation of symptoms and administered treatment options is also very useful to initiate successful treatment. 

 

  • The need for advanced imaging and lab work is determined based on the initial evaluation and response to ongoing treatment.  

 

  • For symptoms that persist beyond 6 weeks and associated with some neurological signs and symptoms of nerve compression, an MRI scan is generally useful for further evaluation. 

 

  • Electrodiagnostic testing such as EMG/NCS are not necessary for routine evaluation of back pain. These tests are used to distinguish lumbar radicular pain from other causes of extremity dysesthesia such as peripheral nerve entrapment (tarsal tunnel syndrome) and peripheral neuropathy (diabetes, vascular, rheumatologic) etc.

Treatment Options

  • Treatment depends on the severity of your back pain as well as the underlying cause. Most cases of low back pain usually respond to conservative measures such as rest, ice, over the counter anti-inflammatory medications (naproxen, ibuprofen, acetaminophen) and time. Sometimes muscle relaxants are also utilized for back spasms. 
  • Physical therapy plays an important role in back pain relief and can help you improve your strength, posture, and flexibility to reduce risk of future flare ups. 
  • Nonsurgical treatment options are offered based on symptoms and underlying diagnosis.

These include: 

Epidural Steroid (cortisone) injections

Sacroiliac (SI joint) cortisone injections

Medial Branch Nerve Blocks/Radiofrequency Ablations (RFA)

Trigger Point Injections

Piriformis Injections

Regenerative Medicine options such as Platelet Rich Plasma (PRP) Therapy

Spinal Cord Stimulation

The team takes an integrative approach to patient care, so your doctor may combine several conservative treatments to relieve your back pain.

Is Surgery Needed For Lower Back Pain?

If no other treatments are working after at least six months, surgery may be necessary for your lower back pain, providing the cause of the pain is identifiable. Options include:

  • Spinal fusion
  • Disk replacement
  • Discectomy/Microdiscectomy
  • Laminectomy/Foraminotomy
  • Where suitable, your surgeon performs these procedures using minimally invasive techniques to reduce tissue damage and shorten recovery time.