Back Pain
Acute low back pain is the fifth most common reason for all visits to orthopedic surgeons, and currently accounts for the second most common reason that patients seek medical attention. While common causes of low back pain include injury, muscle strain related to poor muscle conditioning, and inflammatory processes related to natural degeneration of the lumbar spine, most acute low back pain occurs without any obvious or diagnosable cause. Certain medical conditions may present initially as acute low back pain. For instance, kidney stones, abdominal aneurysms, and infections in or around the spine may present as pain across the low back. Certain cancers also have a predilection to metastasize to the spine and, accordingly, the initial presenting complaint may be that of low back pain. In the elderly, osteoporosis may predispose to spontaneous compression fractures that present as acute low back pain. If pain across the back persists for up to six weeks, medical attention and formal evaluation should be pursued. |
When the outer layer of the intervertebral disc (the annulus fibrosis) is injured, a tear occurs in this collagenous structure. As a result of the tear, a host of inflammatory mediators and enzymes produce substances that the body interprets as painful. It is this inflammatory response that we believe actually causes the back pain. Six weeks, medical attention and formal evaluation should be pursued. |
Degenerative disc disease is the general term used to describe the “drying out” phenomenon that occurs in all spinal discs beyond the age of 30. The lumbar discs are composed of cartilage which, in turn, is composed of approximately 80 percent water by weight. With increasing age, the water content of the intervertebral disc decreases, resulting in loss of disc height and peripheral disc bulging. This natural phenomenon is referred to as degenerative disc disease. This is very easily identified on MRI scans, which look specifically at water content within the discs. Patients should realize that the existence of disc degeneration on MRI does not necessarily correlate with the existence of low back pain. |
Spinal stenosis is the condition whereby the diameter of the spinal canal narrows as the result of progressive degenerative changes. By flexing forward at the waist or changing to a seated position, the affected individual can often alleviate their symptoms. If there is a significant inability to stand and walk, more aggressive treatments would include a course of physical therapy with an emphasis on abdominal strengthening and pelvic tilt exercises. If conservative care with physical therapy does not provide satisfactory relief, a trial of epidural steroid injections may be warranted. A series of one to three epidural steroid injections has been shown to reduce inflammation around the compressed spinal cord and nerve structures, resulting in relief of symptoms. If the patient's symptoms of spinal stenosis continue to recur despite epidural steroid injections, surgical intervention with a decompressive laminectomy, or removal of the bony arch along the back of the spine, may be considered. This is a common procedure that results in increased room for the spinal cord and nerve structures. Typically, patients can expect to regain the ability to stand and walk longer distances after such an intervention. |
If spinal stenosis cannot be treated conservatively with physical therapy and epidural steroid injections, the surgical treatment would involve either a lumbar laminectomy or interspinous process decompression using the minimally invasive X-STOP technique. |