Pain in the Lower Back

WHAT ARE THE CAUSES AND RISK FACTORS?

There are many causes of lower back pain. These include:

• Strains

A common cause of lower back pain, the muscles and ligaments in the lower back can be stretched or torn due to overuse or overactivity.

• Disc injury

The discs in the back are prone to injury, and this risk increases with age. Injury to a disc includes a disc tear or a herniated disc.

A disc tear is when small tears to the outer part of the disc (annulus) occur, mainly due to aging. Some people with disc tears experience no pain at all, while others experience pain that lasts for weeks, months, or even longer. A small number of people may develop constant pain that lasts for years which can be quite disabling.

A herniated disc, also known as a slipped or ruptured disc, occurs when the cartilage surrounding the disc pushes against the spinal cord or nerve roots. The cushion that sits between the spinal vertebrae extends outside its normal position, which can result in compression of the nerve root as it pushes through the vertebral bones. A herniated disc often occurs with lifting or twisting movements.

• Sciatica

Sciatica occurs when the disc presses on the sciatic nerve, which connects the spine to the legs. This can happen along with a herniated disc. Sciatica can cause pain in the legs and feet which usually feels like a burning or pins-and-needles sensation.

• Disc degeneration

Due to aging, intervertebral discs will experience “wear and tear” and start to shrink. They may even collapse completely in certain cases and cause the facet joints in the vertebrae to rub against one another, resulting in pain and stiffness.

“Wear and tear” on the facet joints is also known as osteoarthritis. It can lead to further back problems, including spinal stenosis.

• Spinal stenosis

Spinal stenosis is most commonly due to disc degeneration between the vertebrae.

When disc degeneration occurs and osteoarthritis develops, your body may grow new bone in your facet joints to help support the vertebrae. Over time, this bone overgrowth (called spurs) can lead to a narrowing of the spinal canal, which places pressure on the spinal cord and spinal nerves. Osteoarthritis can also cause the ligaments that connect vertebrae to thicken, which can narrow the spinal canal.

• Scoliosis

This is an abnormal curve of the spine that may develop in children and teenagers. Older patients who have arthritis are also at risk of this condition. If pressure on the nerves is involved, it may also result in leg problems. Other abnormal spine curvatures include kyphosis and lordosis.

Other causes of lower back pain include conditions like arthritis, fibromyalgia, arterial disease and health conditions.

WHAT IS THE DIAGNOSIS?

A history of the injury and a physical examination of the back will be conducted by the Doctor. He will check for pain in different parts of the back and may check the reflexes of your legs in case nerve damage has taken place.

Imaging tests will be taken, such as x-ray, CT scan and MRI scan to check for bone and disc problems.

WHAT ARE THE TREATMENT OPTIONS?

Treatment for back pain starts off with nonsurgical options. These include:

• Medications

Pain relief and anti-inflammatory medications will be prescribed, such as acetaminophen and ibuprofen to reduce pain and swelling.

• Steroid injections

Steroid injections such as corticosteroids may be injected directly into your spine for pain relief.

• Walking aids

You may need to wear a brace to help you move around and be more stable.

• Physiotherapy

Stretching exercises for your back may be recommended to help you relieve lower back pain, regain strength and restore your range of motion.

Should nonsurgical treatment fail to alleviate your lower back pain symptoms, surgery may be recommended. Additionally, you should only consider surgery if you are able to locate the source of your pain. Surgical treatments include:

• Spinal Fusion

The aim of spinal fusion is to fuse together the painful vertebrae so that they heal into a single, solid bone. Spinal fusion cuts down on the motion by removing discs between the vertebral segments. This is because If the painful spine segments do not move, they should not hurt. The vertebrae are then fused together using a bone graft. Screws, rods, or a “cage” are used to keep your spine stable while the bone graft heals.

Spinal fusion can be done through your abdomen, your side or your back. The results of spinal fusion for lower back pain vary, and full recovery can take more than a year.

• Disc Replacement

The aim of disc replacement is to allow the spinal segment to maintain some flexibility and motion. This procedure involves removing the disc and replacing it with artificial parts, similar to a hip or knee replacement.

Disc replacement is done through your abdomen, usually on the lower two disks of the spine.

HOW CAN LOWER BACK PAIN BE PREVENTED?

Although preventing lower back pain may not be possible, there are some measures that we can take to reduce the risks of lower back pain. These include:

• Regular exercise
• Maintaining a healthy weight
• Adopt the proper posture when carrying or lifting objects: keep your back straight and bend your knees when picking something up, instead of bending over to pick it up
• Maintain a proper posture while sitting and standing
• Avoid smoking