Orthopedics

Low Back Pain

What causes low back pain?

Low back pain is one of the most significant health problems today. Pain in the lower back can range from mild, dull, annoying pain to persistent, severe, disabling pain that restricts mobility and interferes with normal functioning.

Low back pain can be caused by a number of factors, including age, obesity, osteoporosis, a herniated disk or strain.

Two common types of back pain stem from issues with intervertebral disks. As we age, the intervertebral disk may lose fluid and become dried out, causing the disk to compress. This may lead to the deterioration of the tough outer ring allowing the nucleus, or the inside of the ring, to bulge out. This is considered a bulging disk. As the disk continues to degenerate, or with continued stress on the spine, the inner nucleus may actually rupture out. This is considered a ruptured or herniated disk. The fragments of disk material can then press on the nerve roots that are located just behind the disk space, causing pain, weakness, numbness or changes in sensation.

What are the symptoms?

  • Muscle ache or spasms

  • Shooting or stabbing pain

  • Pain that radiates to the buttocks or legs

  • Limited range of motion

What treatment options are available?

Medication

For most low back pain, over-the-counter pain medicine like ibuprofen or acetaminophen can ease pain and inflammation. For chronic back pain, your physician may prescribe a stronger pain-killer or muscle relaxer.

Rehabilitation

Generally, there are three phases to low back pain rehabilitation:
Phase 1 - Acute: During this initial phase, the physiatrist and treatment team focus on making a diagnosis, developing an appropriate treatment plan and implementing the treatment regimen to reduce the initial low back pain and source of inflammation. This may include utilization of ultrasound, electrical stimulation or specialized injections.
Phase 2 - Recovery: Once the initial pain and inflammation are better managed, the rehabilitation team then focuses on restoring working function of the body. This includes returning the patient to normal daily activities while implementing a specialized exercise program that is designed to help the individual regain flexibility and strength.
Phase 3 - Maintenance: The goal of this phase is two-fold -- educating the individual on ways to prevent further injury and strain to the back, as well as, helping the individual maintain an appropriate level of physical fitness to help further increase strength and endurance.

Surgical Options

Spinal Fusion
Spinal fusion is a welding process by which two or more of the small bones (vertebrae) that make up the spinal column are fused together with bone grafts and internal devices such as metal rods to heal into a single solid bone. The surgery eliminates motion between vertebrae segments, which may be desirable when motion is the cause of significant pain.
The fused spine must be kept in proper alignment. The patient will be taught how to move properly, reposition, sit, stand and walk. While in bed, the patient will be instructed to turn frequently using a "log rolling" technique in which the entire body is moved as a unit, not twisting the spine. The patient may be discharged from the hospital with a back brace or cast. The family will be taught how to provide care at home.
Anterior Lumbar Fusion
Fusing vertebrae in the lumbar curve may help ease the lower back and leg pain. Anterior lumbar fusion is done through an incision in your stomach area. Depending on how many vertebrae are fused, the surgery may take three to eight hours.
Posterior Lumbar Fusion
Fusing vertebrae in the lumbar curve may help ease lower back and leg pain. Posterior lumbar fusion is done through an incision in your back. The graft is put between the vertebrae in one of two places: in the disk space or between the transverse processes. Depending on how many vertebrae are fused, the surgery may take three to eight hours.