Index
The lumbar spine, or lower back, is a remarkably well-structured structure of interconnected bones, joints, nerves, ligaments, and muscles.
These work together to provide support, strength, and flexibility. However, this complex structure also leaves the lower back susceptible to injury and pain.
To help understand this complicated topic, this article presents a model for understanding symptoms, physical findings, imaging studies, and injection techniques to arrive at an accurate diagnosis.
Once an accurate diagnosis of the cause of low back pain is achieved, treatment options can be selected according to current best medical practices.
The lumbar spine, what can go wrong?
The lower back supports the upper body’s weight and provides mobility for everyday movements such as bending and twisting.
The muscles in the lower back are responsible for flexing and turning the hips while walking and supporting the spine. Nerves in the lower back feed the sensation and enhance the muscles of the pelvis, legs, and feet.
Most acute back pain results from injury to muscles, ligaments, joints, or discs. The body also reacts to the lesions by mobilizing an inflammatory healing response. While inflammation sounds minor, it can cause severe pain.
There is a significant overlap of the nerve supply to many of the discs, muscles, ligaments, and other spinal structures, and it can be difficult for the brain to detect the cause of the pain accurately.
For example, a degenerated or torn lumbar disc may feel like a muscle pull; both create inflammation and painful muscle spasms in the same area. Muscles and ligaments heal quickly, while a torn disc may or may not.
The course of pain time helps determine the cause.
Low back pain can incorporate a wide variety of symptoms. It can be mild and simply annoying, or it can be severe and debilitating. Low back pain may start suddenly, or it may begin slowly, come and go, and gradually worsen over time.
Depending on the underlying cause of the pain, the symptoms can be experienced in several ways. For example:
- Constant pain is contained in the lower back.
- Burning, burning pain that moves from the lower back to the back of the thighs, sometimes in the lower part of the legs or feet; It may include numbness or tingling (sciatica).
- Muscle spasms and oppression in the lower back, pelvis, and hips.
- Pain that gets worse after sitting or standing for a long time.
- Difficulty standing upright, walking, or going from standing to sitting.
In addition, the symptoms of low back pain are usually described by the type of onset and duration:
Acute pain usually appears suddenly, lasts a few days or weeks, and is considered a normal body response to an injury or tissue damage. The pain gradually disappears as the body heals.
Subacute lumbar pain: lasting between 6 weeks and three months, is usually mechanical (such as a muscle strain or joint pain) but is prolonged.
At this point, it can be considered a medical examination, and it is advisable if the pain is severe and limits one’s ability to participate in activities of daily living, sleeping, and working.
Chronic back pain is usually defined as low back pain that lasts more than three months. This type of pain is usually severe, does not respond to initial treatments, and requires a thorough medical examination to determine the exact source of pain.
Types of Lumbar Pain
There are many ways to categorize low back pain; two common types include:
Mechanical pain: by far the most common cause of low back pain, mechanical pain (axial pain) is mainly in the muscles, ligaments, joints (facet joints, sacroiliac joints), or bones in and around the spine.
This type of pain tends to be located in the lower part of the back, the buttocks, and sometimes in the upper part of the legs. It is usually influenced by the load on the spine and may feel different depending on movement (forward / backward / twist), activity, standing, sitting, or resting.
Radicular pain: this type of pain can occur if a spinal nerve root becomes inflamed or affected. Root pain may follow a nerve root or dermatome pattern to the buttock and leg.
Its specific sensation is acute, electrical, burning pain and may be associated with numbness or weakness ( sciatica ). Usually, it feels lonely on one side of the body.
There are many additional sources of pain, including pain from claudication (due to stenosis ), myelopathic pain, neuropathic pain, deformity, tumors, infections, and pain from inflammatory conditions (such as rheumatoid arthritis or ankylosing spondylitis ).
It is also possible that back pain develops without a definite cause. When this happens, the main objective is to treat the symptoms (rather than the cause of the symptoms) and the patient’s general health.
Causes of Low Back Pain
More commonly, mechanical problems and soft tissue injuries cause low back pain. These injuries can include damage to the intervertebral discs, compression of the nerve roots, and inadequate movement of the spinal joints.
The most common cause of low back pain is a muscle torn or torn ligament.
Muscle strain and ligament sprain
A sprain or strain in the lower back can occur suddenly or develop slowly over time due to repetitive movements.
- Tensions occur when a muscle stretches too much and breaks, damaging its power.
- Sprains happen when excessive stretching and tearing affect the bones’ ligaments.
It does not matter if the muscle or ligament is damaged for practical purposes since the symptoms and treatment are the same.
Common causes of sprain and tension include:
- Lifting a heavy object or twisting the spine while lifting.
- Sudden movements exert too much pressure on the lower part of the back, like a fall.
- Poor posture in time.
- Sports injuries, especially in sports that involve sprains or large impact forces.
While sprains and strains do not sound serious and usually do not cause lasting pain, acute pain can be quite severe.
Causes of Lower Back Pain
Pain is considered chronic once it lasts more than three months and exceeds the body’s natural healing process. Chronic pain in the lower back often involves a disc problem, a problem in the joints, and an irritated nerve root.
Common causes include:
Lumbar herniated disc: the gelatinous center of a lumbar disc can pierce the resistant outer layer and irritate a nearby nerve root.
The herniated portion of the disc is filled with proteins that cause inflammation when they reach a nerve root and inflammation and compression of the nerve cause pain in the nerve root.
The disc wall is also abundantly supplied by nerve fibers, and a tear through the wall can cause severe pain.
Degenerative disc disease: at the time of birth, the intervertebral discs are full of water and in their healthiest state. As people age with time, the discs lose moisture and wear.
As the disc loses hydration, it can not withstand forces and transfers force to the disc wall, which can cause tears and cause pain or weakness that can lead to a hernia. The disc can also collapse and contribute to stenosis.
Dysfunction of the facet joint: there are two facet joints behind each disc in each segment of movement in the lumbar spine. These joints have cartilage between the bones and are surrounded by a capsular ligament richly innervated by the nerves.
These joints can be painful on their own or in conjunction with disc pain.
Sacroiliac Joint Dysfunction: The sacroiliac joint connects the sacrum in the lower part of the spine on each side of the pelvis.
It is a robust and low-motion joint that primarily absorbs shock and tension between the upper body and lower body.
The sacroiliac joint can become painful if it becomes inflamed ( sacroiliitis ) or if there is too much or too little movement of the joint.
Spinal stenosis: This condition causes pain by narrowing the spinal canal where the nerve roots meet. The narrowing can be central, formal, or both and can be in a single level or multiple levels in the lower part of the back.
Spondylolisthesis: This condition occurs when one vertebra slides on the adjacent one. There are five types of spondylolisthesis, but the most common are secondary to a defect or fracture of the pair (between the facet joints) or the mechanical instability of the facet joints (degenerative).
The pain can be caused by instability (back) or compression of the nerves (leg).
Osteoarthritis: This condition results from wear of the disc and facet joints. It causes pain, inflammation, instability, and stenosis to a variable degree and can occur at a single level or multiple levels of the lower part of the spine.
Spinal osteoarthritis is associated with aging and is slowly progressive. It is also known as spondylosis or degenerative joint disease.
Deformity: the curvature of the spine may include scoliosis or kyphosis. The deformity may be associated with lower back pain if it leads to rupture of the discs, facet joints, sacroiliac joints, or stenosis.
Trauma: fractures or acute dislocations of the spine can cause pain. Lower back pain that develops after a trauma, such as car accidents or falls, must be medically evaluated.
Compression fracture: a fracture in the cylindrical vertebra, in which the bone essentially sinks in on itself, can cause sudden pain. This type of fracture is more common due to weak bones, such as osteoporosis, and is more common in older people.
It is essential to keep in mind that the presence of one or more of these conditions does not necessarily mean that it is the cause of the pain. For example, osteoarthritis or degenerative disc disease may appear in an imaging study, but the person may not report the nuisance.
Less Common Causes of Low Back Pain
While it is considerably less common, lower back pain can also be caused by:
Infection: Also called osteomyelitis, a rare spinal condition that can cause severe pain and is life-threatening if left untreated. It can be caused by surgical procedures, injections, or dissemination through the bloodstream.
Patients with a compromised immune system are more susceptible to developing an infection in the spine.
Tumor: Most spinal tumors begin in another part of the body and metastasize to the spine. The most common tumors that spread to the spine start with breast, prostate, kidney, thyroid, or lung cancer.
Any new symptom of back pain in a patient with a known cancer diagnosis should be evaluated to detect possible spinal metastases.
Autoimmune disease: back pain is a possible symptom of autoimmune conditions, such as ankylosing spondylitis, rheumatoid arthritis, lupus, Crohn’s disease , fibromyalgia, etc.
This list includes the most common causes of back pain, but there are many more. Finding the optimal treatment for low back pain generally depends on obtaining a correct clinical diagnosis that identifies the underlying cause of the patient’s symptoms.
Symptoms of Low Back Pain
Low back pain may start as acute due to an injury, but it can become chronic. Controlling pain adequately at an early stage can help limit both time and severity of symptoms.
Identifying the symptoms and obtaining a diagnosis that pinpoints the underlying cause of the pain is the first step in getting adequate pain relief.
Common Symptoms of Low Back Problems
Explicitly identifying and describing the symptoms can help lead to a more accurate diagnosis and an effective treatment plan. A combination of the following symptoms usually characterizes low back pain:
Constant pain: the pain in the lower back ( axial pain ) is usually described as dull and aching instead of burning, throbbing, or sharp.
This type of pain may be accompanied by mild or severe muscle spasms, limited mobility, and pain in the hips and pelvis.
Pain that travels to the buttocks, legs, and feet: Lumbar pain sometimes includes a sharp, throbbing, tingling, or numb sensation that moves down the thighs and toward the lower legs and feet, also called sciatica.
Sciatica is caused by irritation of the sciatic nerve and is usually only felt on one side of the body.
Pain worsens after a prolonged session: sitting puts pressure on the discs, making the lower back pain worse after sitting for long periods.
Walking and stretching can quickly relieve low back pain, but returning to the sitting position can reappear symptoms.
Pain that feels better when changing position: depending on the underlying cause of the pain, some parts will be more comfortable than others.
For example, walking normally can be difficult and painful with spinal stenosis, but leaning forward on something, such as a shopping cart, can reduce pain.
How symptoms change with changing positions can help identify the source of pain.
Pain worsens after waking up and improves after moving: many of those who experience low back pain report symptoms that get worse early in the morning.
However, after getting up and moving, the symptoms are relieved. The pain in the morning is due to the stiffness caused by long periods of rest, decreased blood flow during sleep, and possibly the quality of the mattress and the pillows used.
Of course, there are other ways people experience lower back pain. Low back pain varies at the individual level, and many factors influence the experience of pain, including mental and emotional health, financial stress or exercise, and activity level.
Start of Symptoms of Low Back Pain
Depending on the cause of low back pain, the onset of symptoms can vary widely. Back pain may include:
Pain develops slowly over time: symptoms caused by repetitive movements or positions that induce stress tend to appear gradually and progressively worsen.
Pain may develop after certain activities or at the end of a long day and feel like constant pain.
Pain that appears and disappears but gets worse over time: the back pain caused by degenerative disc disease can be felt over time, but the outbreaks of pain become progressively more severe over a long time.
Immediate pain after an injury: sudden or discordant movements can damage the spine and supporting muscles, causing rapid and acute pain.
Delayed symptoms after the injury: sometimes, the symptoms develop or worsen a few hours or days after an accident or injury. Delayed pain is generally considered a side effect of the natural healing processes of the muscles.
Symptoms of Low Back Pain by Location
The largest vertebrae of the body are found in the lumbar spine, supporting most of the upper body’s weight.
These vertebrae are very susceptible to degeneration and injury, and a lesion at a spinal level can cause a specific set of symptoms:
- L3-L4: The nerve root L3-L4 is likely to cause stinging pain in the front of the thigh, possibly including numbness or tingling. The pain or neurological symptoms may radiate to the front of the knee, the shin, and the foot, although it is less common.
- L4-L5: The pain of the L4-L5 segment usually manifests as sciatic pain in the back of the thigh and possibly pain that reaches the calves, combined with axial lumbar pain.
- L5-S1: Where the base of the spine connects to the sacrum, a couple of joints provide support and flexibility.
One is the lumbosacral joint, which allows the hips to oscillate from side to side. The other is the sacroiliac joint, which has limited mobility and mainly absorbs shock from the upper body to the lower part of the body.
The pain of the L5-S1 segment is usually caused by problems with these joints or by a compressed nerve root. Issues with the L5-S1 component commonly cause sciatica.
The different nerve roots are irritated depending on the injured structures in the back. Being able to point out the specific areas of the radicular pain can help diagnose with more precision the source of the lumbar pain.
Symptoms that require immediate attention
Sometimes, low back pain can indicate a severe underlying medical condition. It is recommended that people experiencing any of the following symptoms seek immediate attention:
- Loss of control of the bladder and bowel.
- The recent weight loss is not due to changes in lifestyle, such as diet and exercise.
- Fever and chills.
- Severe and unrelenting pain in the abdomen.
In addition, people who experience pain symptoms after a major trauma (such as a car accident) are recommended to see a doctor.
If back pain interferes with daily activities, mobility, sleep or if there are other worrisome symptoms, seek medical attention.
Chronic low back pain usually correlates with other symptoms. Most people with back pain and leg pain in progress report difficulty sleeping (falling asleep and falling asleep), depression, and anxiety.
Diagnosis of Low Back Pain
Obtaining an accurate diagnosis that identifies the underlying cause of the pain and not only correlates with the symptoms is essential to guide the treatment.
The patient provides a detailed description of the symptoms and medical history as a basis for the diagnostic process. From this information, a doctor will usually have a general idea of the source of the patient’s pain.
History of the Patient
Before starting a physical examination, the patient will be asked to provide information about the symptoms and medical history. The consultations usually include:
Information about current symptoms: Is the pain better or worse at certain times, such as waking up or after work? How far does the pain extend? Are there other symptoms simultaneously, such as weakness or numbness? How does the pain feel, sharp, tight, dull, hot, throbbing?
Activity level: Does the person lead a generally more active or passive lifestyle? For example, does work require sitting at a desk or standing on an assembly line for long periods? How often does the person exercise?
Sleep habits: As a general rule, how many hours of sleep does the patient receive? What position to sleep in is the preferred one? What type and quality of mattress and pillow does the patient use?
Posture: What type of posture is comfortable or uncomfortable? Does the patient typically feel upright or stooped?
Injuries: Has the person had a recent injury? Has there been an injury in the past that could be relevant now?
The answers to these questions provide the doctor with a complete picture of the patient’s daily life, which indicates more specific possibilities for low back pain. Medical history is usually the most powerful tool for finding a diagnosis.
Physical exam
A physical examination aims to reduce the possible causes of pain further. A typical physical examination for low back pain includes a combination of the following steps:
Palpation: a doctor will feel with the hand (also called palpation) along the lower back to locate any spasms, muscle stiffness, tenderness, or joint abnormalities.
Neurological exam: The diagnosis will probably include a motor examination, which provides for manual movement of the extension and flexion of the hip, knee, and big toe (forward and backward movement), as well as the direction of the ankle.
A sensory examination probably includes proof of the patient’s reaction to light touch, a prick, or other senses on the trunk, buttocks, and lower legs.
Range of motion test: the patient may be asked to bend or twist in certain positions. These activities look for places that worsen or recreate pain and see if specific movements are limited by discomfort.
Reflex test: the reflexes of the patient on the legs will be reviewed to evaluate the weakened reflexes and the decrease in muscle strength. If the reflexes decrease, a nerve root may not respond as it should.
Leg augmentation test: the patient is asked to lie on his back and lift one leg as high and straight as possible. If this leg augmentation test recreates the low back pain, you might suspect a herniated disc.
A doctor can diagnose low back pain based on information obtained from a medical history and a physical examination, and no further tests are necessary.
Diagnostic Imaging
Sometimes an imaging scan is needed to get more information about the cause of the patient’s pain. An imaging test may be indicated if the patient’s pain is severe, is not relieved in two or three months, and does not improve with nonsurgical treatments.
Standard imaging tests include:
X-rays: are used to observe the bones of the spine. They show abnormalities, such as arthritis, fractures, bone spurs, or tumors.
A computed tomography/myelogram: provides a cross-sectional image of the spine.
An x-ray is sent through the spine in a CT scan, which a computer lifts and reformats in a 3D image.
This detailed image allows doctors to look closely at the spine from different angles.
Sometimes a myelogram is performed in tandem with a CT scan, in which a dye is injected around the nerve roots to highlight the spinal structures, which gives the image more clarity.
MRI scan: provides a detailed picture of the spinal structures without using the radiation required with X-rays. An MRI scan can detect abnormalities in soft tissues, such as muscles, ligaments, and intervertebral discs.
An MRI can also locate misalignment or joint overgrowth in the spine.
Injection studies are fluoroscopic directed injections of local anesthetic and steroid medication in specific anatomical structures. They help confirm the source of pain.
They are used in diagnosis and rehabilitation and are considered predictive of surgical outcomes.
Sometimes doctors know what causes back pain but not precisely where it is happening, so an imaging test will be used to locate the source more precisely.
Imaging tests are also used for patients who undergo surgery so that doctors and surgeons can plan the procedure.
Treatments for Low Back Pain
Many treatment options for low back pain can be adapted to an individual patient’s needs. Treatments include home-managed care, medicinal remedies, alternative care, or surgery.
Depending on the patient’s diagnosis, some treatments may be more effective than others. Many people find that a combination of treatments is the best.
Personal Care for Lumbar Pain
Essential home remedies can be effective in treating mild or acute pain of muscle strain and reducing the effects of chronic and severe pain.
Personal care is administered by the individual and can be easily adjusted. These methods include:
Short rest periods: many episodes of low back pain can be improved by briefly avoiding strenuous activity. It is not advisable to rest for more than a few days since excessive inactivity can hinder healing.
Modification of the activity: a variant of rest is staying active but avoiding the movements and positions that aggravate the pain.
For example, if long periods sitting in a car or on a desk make the pain worse, set a timer to get up every 20 minutes and walk or stretch gently.
If stopping makes the pain worse, avoid the tasks that require stopping, such as washing the dishes in the sink.
Avoiding or minimizing activities and positions that worsen pain will help prevent or reduce painful back spasms and allow a better healing environment.
Cold/heat therapy: the warmth of a warm bath, a hot water bottle, an electric heating pad, or chemical or adhesive thermal wraps can relax tight muscles and improve blood flow.
Increased blood flow provides nutrients and oxygen that the muscles need to heal and stay healthy. If the lower back is painful due to inflammation, ice or cold packs may be used to reduce swelling. It is essential to protect the skin while applying heat and ice to prevent tissue damage.
Alternating heat and cold can be beneficial when you return to activity: applying heat before activities helps relax the muscles, allowing for better flexibility and mobility; using ice after the move reduces the chances of an area becoming irritated and inflamed when you exercise.
Medications for pain: the most common drugs are aspirin (for example, Bayer), ibuprofen (for example, Advil ), naproxen (for example, Aleve ), and paracetamol (for example, Tylenol ).
Aspirin, ibuprofen, and naproxen are anti-inflammatory medications that relieve low back pain caused by swelling of the nerves or muscles. Paracetamol works by interfering with pain signals sent to the brain.
Self-care treatments usually do not need a doctor’s guidance, but they should be used with care and attention. Any type of medication carries possible risks and side effects.
If a patient is not sure what type of self-care would work best, it is recommended to consult a doctor.
Exercises for Lumbar Pain
Physical therapy is usually part of a low back pain control regimen. The types of exercises used to rehabilitate the spine include:
Stretching: almost everyone can benefit by stretching the muscles of the lower back, buttocks, hips, and legs (especially the hamstring muscles).
These muscles support the weight of the upper body. The more mobile these muscles are, the more you can move your back without hurting yourself. It is recommended to start a slight stretch for 20 to 30 seconds and stop a bit if it causes pain.
Strengthening exercises: strengthening the abdominal, hip, and gluteal muscles that support the spine, also called central powers, can help relieve lower back pain. Two standard programs are the McKenzie method and dynamic lumbar stabilization.
- McKenzie’s method extends the spine by constructing central muscle strength, reducing the pain caused by compressed spinal structures, such as a herniated disc caused by a compressed disc space.
- Dynamic lumbar stabilization strengthens the back muscles to maintain the patient’s “neutral spine” or the posture that feels most comfortable.
Low impact aerobics: Low impact aerobic exercise increases blood flow and helps heal an injury without shaking the spine.
Low-impact aerobics can include stationary bicycles, elliptical or passing machines, walking, and water therapy.
People with low back pain who regularly do aerobic exercise report fewer recurrent pain episodes and are more likely to stay active and functional when the pain worsens.
Any exercise that raises the heart rate for a sustained period benefits the body. Regular physical activity is essential to maintain the range of motion and flexibility of a healthy spine.
When the spinal structures are not used for a long time, the stiffness and discomfort may worsen.
Nonsurgical Treatments for Low Back Pain
The goal of medical treatments is to reduce pain, but these treatments do not change the underlying source of pain. Usually, a doctor will prescribe medical therapies and a physiotherapy program or other regimen.
Common medical treatments include:
Muscle relaxants: this medication acts as a central nervous system depressant and increases the mobility of tense muscles, relieving the pain of muscle tension or spasms. Muscle relaxants have no role in the control of chronic pain.
Narcotic pain medications: Narcotic medications, also called opioids or pain killers, alter the perception of pain by weakening the signals sent to the brain.
Narcotic medications are most often used to treat severe pain in the short term, such as acute pain after an operation. Narcotics are rarely used to treat long-term pain, as they have many side effects and can quickly become addictive.
Orthopedic device: Some patients find that a brace may be used to provide comfort and possibly reduce pain.
There is some evidence that using an inelastic corset-style corset, worn daily, in combination with a physical therapy exercise program, can accelerate healing and reduce pain.
A back orthosis can also be helpful after back surgery.
Epidural steroid injections involve a steroid administered directly to the outside of the dural sac, which surrounds the spinal cord. A live x-ray, called fluoroscopy, guides the needle into the correct area.
The goal of the injection is to temporarily relieve pain by reducing inflammation around a compressed nerve root.
Medical treatments are often used in combination with other methods. For example, an epidural steroid injection can provide enough pain relief in the short term to allow progress in physical therapy.
Alternative Treatments
Non-medical treatments can be referred to as alternative or complementary care. The term “alternative” should not imply inferiority but is not traditional according to western medical standards.
Many patients with low back pain report relief from alternative treatments. Common options include:
Manual manipulation: a chiropractor or other health care provider makes physical adjustments to the spine to improve mobility and reduce stiffness, discomfort, or pain.
Manual thrusts of variable speed and force are applied to adjust the spinal structures. Manual manipulation has been found to relieve low back pain in some people.
Acupuncture: based on ancient Chinese medicine, acupuncture stimulates points in the body designed to correct the “qi” of the body or the force of life. It is believed that adequate qi decreases pain and discomfort in the body.
Thin needles are placed on the skin for about an hour during a session. It has been shown that acupuncture provides significant pain relief for some people.
Massage Therapy: massage therapy can relieve muscle spasms that generally contribute to low back pain when applied to the lower back.
Massage also increases blood flow to the lower back, which speeds healing by providing nutrients and oxygen to damaged muscles.
Conscious meditation: meditation can help reduce pain perception and reduce the depression, anxiety, and sleep problems that commonly occur with chronic pain.
Meditative techniques for pain reduction range from deep breathing exercises to an altered focus approach.
The above is not a complete list; many more treatment options are available, including newer and less invasive surgical options.
Surgery for Low Back Pain
Surgery can be considered if severe lower back pain does not improve after a 6-12 week cycle of nonsurgical treatments.
It is almost always the patient’s decision to undergo back surgery, and only rarely is immediate surgery performed for low back pain. Some factors to consider before having a back surgery include:
Ability to function: if it is possible to complete activities of daily living with manageable levels of pain, and if the pain does not interrupt sleep or exercise, nonsurgical treatments are generally recommended.
It is more likely that surgery is recommended if the patient has a limited capacity to function in daily life.
Recovery process and lifestyle: surgery versus nonsurgical care requires a varying time commitment. It is essential to consider how the healing process after surgery will affect the patient, as opposed to continuous nonsurgical care.
Type of surgery: Some surgeries are considerably more invasive than others and include more extended periods of healing, more or less significant pain during recovery, and variable hospital stays in the hospital.
With modern surgical approaches and an experienced surgeon, many types of spinal surgery can now be performed on an outpatient basis with a shorter recovery period.
Mental health: several studies have indicated that mental and emotional well-being positively correlates with improvement and satisfaction after surgery.
Patients who feel more in control of their health, for example, report a recovery and more positive results after surgery. Understanding how a patient can respond to surgery can help guide more effective postoperative care.
Spine surgery is usually not recommended for mild to moderate back pain or pain that lasts less than 6 to 12 weeks. In addition, back surgery is not an option if the cause of the pain is not detectable through imaging tests.
Decompression surgeries
A decompression surgery removes everything pressing on a nerve root of the spine, which can include a herniated portion of a disc or a bone spur. There are two main types of decompression for low back pain.
- Microdiscectomy is a minimally invasive procedure for patients with a lumbar herniated disk that causes radicular pain in the leg (sciatica).
- A laminectomy removes part of the bone or soft tissue layer compressing a nerve or multiple nerve roots.
Usually, a laminectomy will be performed for someone with pain and weakness in the leg due to spinal stenosis caused by changes in the facet joints, discs, or bone spurs.
Decompression surgery can be performed with open or minimally invasive techniques with relatively small incisions and minimal discomfort and recovery before returning to work or other activities.
Most of these procedures are now performed as outpatient surgery or with an overnight stay.
Spinal Lumbar Fusion Options
Fusion surgery removes the soft tissues between two adjacent vertebral bones and replaces them with bone or metal.
This procedure allows bones to grow together over time, usually 6 to 12 months, and fuse into a long bone to stabilize and eliminate movement in those spinal segments.
In the lumbar spine, the fusion can be done from the back (posterior approach), the front (anterior approach), the lateral (lateral direction), or combined.
Modern techniques, implants, navigation, and biological products have made the surgery more predictable with an easier recovery and return to regular activity and work.
The most reliable indications for lumbar spinal fusion include spondylolisthesis, fracture, instability, deformity, degenerative disc disease, and stenosis.
For low back pain caused by dysfunction of the sacroiliac joint, a fusion of the sacroiliac joint is an option. Tumors and infections are also treated with fusion surgery, but these conditions are much less common.
Other Surgical Options
Some newer surgical options that are used for some cases of low back pain include:
Artificial lumbar disc: for some patients, disc replacement is a potential alternative to fusion surgery for degenerative symptomatic disc disease.
This procedure has the potential for faster recovery and maintaining more spinal movement than lumbar fusion. Long-term data is still being collected.
Posterior movement device: the Coflex interlaminar device is an alternative to fusion for stenosis and mild degenerative spondylolisthesis.
This approach aims to obtain results similar to fusion but with minor surgery and a faster recovery. Long-term data is still being collected.
This is not a complete list of surgical options. Several others exist or are in development. The technologies used today and in development include stem cells, nanotechnologies, and robotics.
Postoperative Care of Low Back Surgery
The recovery period after lower back surgery depends on several factors, including the patient’s condition before surgery, the extent of the surgery, and the skill and experience of the surgeon. For example:
- A microdiscectomy for a lumbar disc herniation is considered minimally invasive, and the patient usually does not have a nocturnal hospitalization, and the recovery time is approximately one week.
- A lumbar fusion may involve a nocturnal hospital stay, a slow return to daily activities, and possibly some activity restrictions as the merger is established for the next 3 to 12 months.
Physiotherapy is usually prescribed to rebuild strength and range of motion and stimulate healing.
Patients have also often been prescribed analgesics or muscle relaxants. Some patients may be recommended to use a back brace or unique beds, shower benches, or supportive pillows to facilitate healing.
In general, recovering patients are advised to take a short rest period while healing the spine and surrounding tissues.
