Low Back Pain
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 your back) are cushioned by small, round, flat discs with a tough outer layer that surrounds a jellylike material called the nucleus. Located between each of your vertebra in the spinal column, discs act as shock absorbers for the spinal bones. Thick ligaments attached to the vertebrae hold the pulpy disc material in place.
Pain may arise from instability in the spine or from compression caused by disc herniation, lumbar spinal stenosis, osteoarthritis and other disorders. Although low back pain can be debilitating, pain improves without surgery in about 90 percent of patients.
A pain medicine specialist will diagnose your low back pain based on your history, symptoms, a physical examination and results of diagnostic studies. We treat some patients with medication or physical therapy before ordering imaging studies, which may include:
- CT scan
- Electromyography (EMG)
- Nerve conduction studies (NCS)
- Selective nerve root block
If low back pain occurs after an injury, call your primary care physician immediately. Seek medical care immediately if you have neurological problems – numbness, weakness or bowel and bladder dysfunction.
We begin treatment with conservative options, including physical therapy, back exercises, weight reduction, steroid injections, non-steroidal anti-inflammatory medications, rehabilitation and limited activity. All of these treatment options are aimed at relieving inflammation in the back and irritation of nerve roots. We usually recommend at least four to six weeks of conservative therapy before you consider surgery.
Injections called selective nerve root blocks help us diagnose the cause of nerve root pain and are also used to provide relief of low back pain or leg pain. Fluoroscopy is used to ensure that the medication is delivered to the right location.
You may be a candidate for surgery if:
- Back and leg pain limits or impairs your quality of life.
- You develop progressive neurological deficits, such as leg weakness and/or numbness.
- You experience loss of normal bowel and bladder functions.
- You have difficulty standing or walking.
- Medication and physical therapy are ineffective.
- Your health is otherwise good.
Neurosurgeons use a number of surgical procedures to help relieve pressure on the nerve roots. If there are several nerve roots and discs causing the pain or if there is degeneration and instability in the spinal column, the neurosurgeon may recommend fusing the vertebrae together with bone grafts and stabilizing the vertebrae with instrumentation, including metal plates, screws, rods and cages.
A successful fusion will prevent the disc from bulging or herniating again. Following a fusion procedure, you will most likely regain restored mobility in the back, including the ability to bend over. Postoperative physical therapy may also help improve mobility.
The benefits of surgery should always be weighed carefully against its risks. Although a large percentage of low back pain patients report significant pain relief after surgery, there is no guarantee that surgery will help every individual.
Source: American Association of Neurological Surgeons