Low Back Pain
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Low back pain is a common disorder that affects millions of individuals each year. Back pain is the single most common cause of lost workdays in the United States and is one of the most common reasons for patients to visit their primary care physicians. In fact, it is estimated that 50 to 80% of the adult population suffers from a memorable episode of low back pain each year.
Most cases of back pain are due to sprain, strain, muscle spasm, and/or intervertebral disc degeneration. These types of pain can be difficult to bear, but the good news is that they generally get better with conservative (non-surgical) treatment: medication, physical therapy, heat or cold packs, etc.
The neurosurgeons at the Spine Hospital at the Neurological Institute of New York handle the few remaining cases—only those cases of back pain that may require surgery. The back pain in these cases may be caused by:
- spinal stenosis, a narrowing of the spinal canal
- spondylosis, stiffening from wear-and-tear on the spine
- developmental disorders
- tumors
- trauma
- …or other factors
Symptoms
Most cases of low back pain will not need surgery. However, the following symptoms are potential “red flags” that might lead a patient to see a neurosurgeon.
- Back pain accompanied by bowel or bladder incontinence and/or numbness in the areas that would sit on a saddle (so-called saddle anesthesia)—these may indicate a medical emergency called cauda equina syndrome
- Back pain that includes weakness, numbness, or pins-and-needles in the legs–may indicate spinal cord compression
- Back pain that radiates down the buttock, leg, or foot for more than a few weeks–may indicate radiculopathy
- Back pain accompanied by fever—may indicate an abscess
- Back pain that gets worse during the night
- Back pain accompanied by unexplained weight loss
- Back pain that continues for several weeks or months
- Back pain following a fall, motor vehicle injury or other trauma–should be medically evaluated immediately
Diagnosis
The following diagnostic procedures may help determine the cause of low back pain:
- X-rays: although X-rays cannot show soft tissue like discs, they provide details of the bone structures in the spine.
- Magnetic resonance (MR) imaging scan: this type of scan provides a detailed image of soft tissues, allowing surgeons to see whether the nerves, discs, and spinal canal space are affected.
- Computed tomography (CT) scan: provides a more detailed image of bone structures in the spine than X-rays.
- Myelogram: a diagnostic procedure that uses contrast dye to provide detailed images of the spinal cord and nerve roots.
Risk Factors
Lower back pain can be caused by any of the following:
- Back muscle strain
- Trauma from a motor vehicle accident
- Spondylosis
- Sciatica
- Lumbar herniated disc
- Degenerative disc disease
- Sacroiliac joint disease
- Lumbar spinal stenosis
- Spinal compression fracture
Less common causes of lower back pain may include:
- Osteomyelitis (infection of the bones in the spine)
- Spinal Tumor
- Fibromyalgia
- Ankylosing spondylitis
The causes of back pain are incredibly varied. If you are experiencing any of the “red flags” above, if your back pain is severe, or if it persists despite conservative care, consider making an appointment.
Treatments
In many cases, low back pain can be safely and effectively treated with non-operative measures such as physical therapy and pain medications.
Surgery is reserved for cases of severe pain, symptoms that do not respond to non-operative therapy, and serious conditions that may endanger the spinal cord or surrounding nerves. Surgical treatments vary widely and depend on the ultimate cause of the back pain.