Low Back Pain: Lumbar Spine, Symptoms, Types of Pains, Causes, Diagnosis and Treatments

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 weight of the upper body 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, as well as 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 is the result of 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 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 accurately detect the cause of the pain.

For example, a degenerated or torn lumbar disc may feel the same as a muscle pull, both create inflammation and painful muscle spasm 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 start slowly, possibly come and go, and gradually get worse over time.

Depending on the underlying cause of the pain, the symptoms can be experienced in several ways. For example:

  • Constant pain, 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 type of onset and duration:

Acute pain : this type of pain usually appears suddenly and lasts a few days or weeks, and is considered a normal response of the body to an injury or tissue damage. The pain gradually disappears as the body heals.

Subacute lumbar pain : lasting between 6 weeks and 3 months, this type of pain is usually of a mechanical nature (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 : usually defined as low back pain that lasts more than 3 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 pain mainly of 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 root of the spinal nerve becomes inflamed or affected. Root pain may follow a pattern of nerve root or dermatome to the buttock and / or 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, 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 general health of the patient.

Causes of Low Back Pain

More commonly, mechanical problems and soft tissue injuries are the cause of 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 and / or torn or torn ligament.

Muscle strain and ligament sprain

A sprain or strain in the lower back can occur suddenly, or it can develop slowly over time due to repetitive movements.

  • Tensions occur when a muscle stretches too much and breaks, damaging the muscle itself.
  • Sprains occur when excessive stretching and tearing affect the ligaments, which connect the bones to each other.

For practical purposes, it does not matter if the muscle or ligament is damaged, 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 that 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, the 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 / or 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 that 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, which is 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 strong, 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 through narrowing of the spinal canal where the nerve roots meet. The narrowing can be central, forminal 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 5 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 is the result of 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 at 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 a car accident or a fall, must be medically evaluated.

Compression fracture: a fracture that occurs 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 important 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 pain.

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 spinal infection is rare but 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 begin with cancer of the breast, prostate, kidney, thyroid, or lung.

Any new symptom of back pain in a patient with a known diagnosis of cancer should be evaluated to detect possible spinal metastases.

Autoimmune disease : back pain is a possible symptom associated with autoimmune conditions, such as ankylosing spondylitis , rheumatoid arthritis , lupus, Crohn’s disease , fibromyalgia and others.

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 symptoms in both time and severity.

Identifying the symptoms and obtaining a diagnosis that identifies the underlying cause of the pain is the first step in obtaining effective pain relief.

Common Symptoms of Low Back Problems

Specifically identifying and describing the symptoms can help lead to a more accurate diagnosis and an effective treatment plan. Low back pain is usually characterized by a combination of the following symptoms:

Constant pain : the pain that remains 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 usually only felt on one side of the body.

Pain that gets worse after a prolonged session : sitting puts pressure on the discs, which makes the lower back pain worse after sitting for long periods of time.

Walking and stretching can quickly relieve low back pain, but returning to the sitting position can lead to the reappearance of symptoms.

Pain that feels better when changing position : depending on the underlying cause of the pain, some positions will be more comfortable than others.

For example, with spinal stenosis, walking normally can be difficult and painful, 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 that gets worse after waking up and better 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 in which 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 that develops slowly over time : symptoms caused by repetitive movements or positions that induce stress tend to appear slowly and progressively worsen.

Pain may develop after certain activities or at the end of a long day, and may feel like constant pain.

Pain that appears and disappears, but that gets worse over time : the back pain caused by degenerative disc disease can be felt from time to time, but the outbreaks of pain become progressively more severe over a long period of time.

Immediate pain after an injury : sudden or discordant movements can damage the spine and its supporting muscles, causing immediate 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 to be 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 weight of the upper body.

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 as well, 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, there are a couple of joints that provide support and flexibility.

One is the lumbosacral joint, which allows the hips to oscillate from side to side, and 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. Problems with the L5-S1 segment commonly cause sciatica.

The different nerve roots are irritated depending on the structures in the back that are injured, and being able to point out the specific areas of the radicular pain can help to diagnose with more precision the source of the lumbar pain.

Symptoms that require immediate attention

Sometimes, low back pain can indicate a serious 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 / or leg pain in progress report difficulty sleeping (falling asleep and / or 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 important to guide the treatment.

As a basis for the diagnostic process, the patient provides a detailed description of the symptoms and medical history. 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 of the day, such as waking up or after work? How far does the pain extend? Are there other symptoms at the same time, such as weakness or numbness? How does the pain feel, aching, sharp, tight, dull, hot, throbbing?

Activity level : Does the person lead a generally more active or sedentary lifestyle? For example, does work require sitting at a desk or standing on an assembly line for long periods of time? 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 is the preferred one? What type and / or 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 more complete picture of the patient’s daily life, which indicates more specific possibilities for low back pain. A medical history is usually the most powerful tool to find a diagnosis.

Physical exam

The goal of a physical examination is to further reduce the possible causes of pain. A typical physical examination for low back pain includes some combination of the following steps:

Palpation : a doctor will feel with the hand (also called palpation) along the lower back to locate any spasm or muscle stiffness, tenderness areas or joint abnormalities.

Neurological exam : The diagnosis will probably include a motor examination, which includes manual movement of the extension and flexion of the hip, knee and big toe (forward and backward movement), as well as the movement 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 are performed to look for positions that worsen or recreate pain, and to see if certain 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.

In general, 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 non-surgical treatments.

Common 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.

In a CT scan an x-ray is sent through the spine, 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 be used to locate misalignment or joint overgrowth in the spine.

Injection studies : they are fluoroscopic directed injections of local anesthetic and steroid medication in specific anatomical structures. They are useful to confirm the source of pain.

They are used in diagnosis, along with rehabilitation, and are considered predictive of surgical outcomes.

Sometimes doctors know what causes back pain, but not exactly where it is happening, so an imaging test will be used to locate the source more specifically.

Imaging tests are also used for patients who undergo surgery so that doctors and surgeons can plan the procedure beforehand.

Treatments for Low Back Pain

Many treatment options for low back pain can be adapted to the needs of an individual patient. Treatments include home-managed care, medicinal remedies, alternative care or even 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

Basic home remedies can be effective in treating mild or acute pain of muscle strain, as well as to reduce 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 to stay active, but avoid the activities and positions that aggravate the pain.

For example, if long periods of time 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 important to protect the skin while applying heat and ice to prevent tissue damage.

Alternating heat and cold can be especially useful when you return to activity: applying heat before activities helps relax the muscles, allowing for better flexibility and mobility; applying ice after the activity reduces the chances of an area becoming irritated and inflamed when you exercise.

Medications for pain : the most common medications 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. In general, it is recommended to start a small stretch for 20 to 30 seconds and stop a stretch if it causes pain.

Strengthening exercises : strengthening the abdominal, hip and gluteal muscles that support the spine, also called central muscles, can help relieve lower back pain. Two common programs are the McKenzie method and lumbar dynamic stabilization.

  • McKenzie’s method extends the spine through the construction of 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 healing an injury without shaking the spine.

Low-impact aerobics can include the use of stationary bicycles, elliptical or passing machines, walking and water therapy.

People with low back pain who regularly do aerobic exercise report fewer recurrent episodes of pain and are more likely to stay active and functional when the pain gets worse.

Any exercise that raises the heart rate for a sustained period of time benefits the body. Regular physical activity is important 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.

Non-Surgical 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 treatments along with 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 easily 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 the use of 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 useful after back surgery.

Epidural steroid injections: this injection involves a steroid administered directly to the outside of the dural sac, which surrounds the spinal cord. A live x-ray, called fluoroscopy , is used to guide 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.

During a session, thin needles are placed on the skin for about an hour. It has been shown that acupuncture provides significant pain relief for some people.

Massage Therapy : applied to the lower back, massage therapy can relieve muscle spasms that generally contribute to low back pain.

Massage also increases blood flow to the lower back, which speeds healing by providing nutrients and oxygen to damaged muscles.

Conscious meditation: meditation can be useful in reducing the perception of pain and can 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; There are many more treatment options 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 pain does not interrupt sleep or activity, non-surgical 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 non-surgical care require varying degrees of time commitment. It is important to consider how the healing process after surgery will affect the patient, as opposed to continuous non-surgical care.

Type of surgery : Some surgeries are considerably more invasive than others, and include longer 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 have a positive correlation 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 that is 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.

  • Microdiskectomy is a minimally invasive procedure for patients with a lumbar herniated disk that causes radicular pain in the leg (sciatica).
  • Laminectomy removes part of the bone or soft tissue layer that is compressing a nerve or multiple nerve roots.

Usually, a laminectomy will be performed for someone with pain and / or weakness in the leg due to a spinal stenosis caused by changes in the facet joints, discs or bone spurs.

A 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 basically removes the soft tissues between two or more 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 approach) or combined.

Modern techniques, implants, navigation and biological products have made surgery more predictable with easier recovery and return to normal 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, 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 to maintain 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.

The objectives of this approach are to obtain results similar to those of fusion, but with a smaller 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 a number of 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, range of motion and stimulate healing.

Patients also often prescribe analgesics or muscle relaxants, and some patients may be recommended to use a back brace or special beds, shower benches, or supportive pillows to facilitate the healing process.

In general, recovering patients are advised to take a short rest period while healing the spine and surrounding tissues.

Most patients take a short break from work, from a few weeks to a couple of months, to avoid overexerting the spinal structures.