Low Back Pain (Lumbar)

Almost everyone will experience low back pain at some point in their lives. This pain can vary from mild to severe. It can be short-lived or long-lasting. However it happens, low back pain can make many everyday activities difficult to do.

Back pain is different from one person to the next. The pain can have a slow onset or come on suddenly. The pain may be intermittent or constant. In most cases, back pain resolves on its own within a few weeks.

There are many causes of low back pain. It sometimes occurs after a specific movement such as lifting or bending. Just getting older also plays a role in many back conditions.

As we age, our spines age with us. Aging causes degenerative changes in the spine. These changes can start in our 30s — or even younger — and can make us prone to back pain, especially if we overdo our activities.

These aging changes, however, do not keep most people from leading productive, and generally, pain-free lives. We have all seen the 70-year-old marathon runner who, without a doubt, has degenerative changes in her back!

Over-Activity

One of the more common causes of low back pain is muscle soreness from over-activity. Muscles and ligament fibers can be overstretched or injured.

This is often brought about by that first softball or golf game of the season, or too much yard work or snow shoveling in one day. We are all familiar with this “stiffness” and soreness in the low back — and other areas of the body — that usually goes away within a few days.

Disc Injury

Some people develop low back pain that does not go away within days. This may mean there is an injury to a disc.

Disc tear

Small tears to the outer part of the disc (annulus) sometimes occur with aging. Some people with disc tears have no pain at all. Others can have pain that lasts for weeks, months, or even longer. A small number of people may develop constant pain that lasts for years and is quite disabling. Why some people have pain and others do not is not well understood.

Disc Herniation

Another common type of disk injury is a “slipped” or herniated disc.

A disk herniates when its jelly-like center (nucleus) pushes against its outer ring (annulus). If the disc is very worn or injured, the nucleus may squeeze all the way through.

When the herniated disc bulges out toward the spinal canal, it puts pressure on the sensitive spinal nerves, causing pain.

Because a herniated disc in the low back often puts pressure on the nerve root leading to the leg and foot, pain often occurs in the buttock and down the leg. This is called sciatica.

A herniated disc often occurs with lifting, pulling, bending, or twisting movements.

Disc Degeneration

With age, intevertebral discs begin to wear away and shrink. In some cases, they may collapse completely and cause the facet joints in the vertebrae to rub against one another. Pain and stiffness result.

This “wear and tear” on the facet joints is referred to as osteoarthritis. It can lead to further back problems, including spinal stenosis.

Degenerative Spondylolisthesis

(Spon-dee-low-lis-THEE-sis). Changes from aging and general wear and tear make it hard for your joints and ligaments to keep your spine in the proper position.

The vertebrae move more than they should, and one vertebra can slide forward on top of another. If too much slippage occurs, the bones may begin to press on the spinal nerves.

Spinal Stenosis

Spinal stenosis occurs when the space around the spinal cord narrows and puts pressure on the cord and spinal nerves.

Osteoarthritis

When intervertebral discs collapse and osteoarthritis develops, your body may respond by growing 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. 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, most often during their teenage years. It also may develop in older patients who have arthritis. This spinal deformity may cause back pain and possibly leg symptoms, if pressure on the nerves is involved.

Additional Causes

There are other causes of back pain, some of which can be serious. If you have vascular or arterial disease, a history of cancer, or pain that is always there despite your activity level or position, you should consult your primary care doctor.

Pain from cervical spondylosis can be mild to severe. It is sometimes worsened by looking up or down for a long time, or with activities such as driving or reading a book. It also feels better with rest or lying down.

Additional Symptoms Include:

• Neck pain and stiffness (may be worse with activity)
• Numbness and weakness in arms, hands, and fingers
• Trouble walking, loss of balance, or weakness in hands or legs
• Muscle spasms in neck and shoulders
• Headaches
• Grinding and popping sound/feeling in neck with movement

Nonsurgical Treatment

Physical Therapy

Strengthening and stretching weakened or strained muscles is usually the first treatment that is advised. Your physical therapist may also use cervical (neck) traction and posture therapy. Physical therapy programs vary, but they generally last from 6 to 8 weeks. Sessions are scheduled 2 to 3 times a week.

Medications

Several medications may be used together during the first phase of treatment to address both pain and inflammation.

Acetaminophen

Mild pain is often relieved with acetaminophen.  Non-steroidal anti-inflammatory drugs (NSAIDs). Often prescribed with acetaminophen, drugs like ibuprofen and and naproxen are considered first-line medicines for neck pain. They address both pain and swelling, and may be prescribed for a number of weeks, depending on the specific problem. Other types of pain medicines can be considered if you have serious contraindications to NSAIDs, or your pain is not well controlled.

Muscle relaxants

Medications such as cyclobenzaprine or carisoprodol can also be used in the case of painful muscle spasms.

Soft Collars

These collars limit neck motion and allow the muscles of the neck to rest. Soft collars should only be worn for short periods of time because long-term wear can decrease the strength of neck muscles.

Ice, heat, other modalities

Careful use of ice, heat, massage, and other local therapies can help relieve symptoms.

Steroid-Based Injections

Many patients find short-term pain relief from steroid injections. Various types of these injections are routinely performed. The most common procedures for neck pain include:

Cervical Epidural Block

In this procedure, steroid and anesthetic medicine is injected into the space next to the covering of the spinal cord (“epidural” space). This procedure is typically used for neck and/ or arm pain that may be due to a cervical disk herniation, also known as radiculopathy or a “pinched nerve.”

Cervical Facet Joint Block

Steroid and anesthetic medicine is injected into the capsule of the facet joint in this procedure. The facet joints are located in the back of the neck and provide stability and movement. These joints can develop arthritic changes that may contribute to neck pain.

Medial Branch Block and Radiofrequency Ablation

This procedure is used in some cases of chronic neck pain. It can be used for both diagnosis and treatment of a potentially painful joint.

Medial branch block and radiofrequency ablation. This procedure is used in some cases of chronic neck pain. It can be used for both diagnosis and treatment of a potentially painful joint.
Facet joint injection in the cervical spine.

During the diagnosis portion of the procedure, the nerve that supplies the facet joint is blocked with a local anesthetic (like the medicine used by your dentist). Your doctor will ask if your neck pain is completely gone. If so, then your doctor has pin-pointed the source of your neck pain.

The next step is to block the pain more permanently. This is done by damaging the nerve with radiofrequency, a procedure called radiofrequency ablation.

Although less invasive than surgery, steroid-based injections are prescribed only after a complete evaluation by your doctor. Before considering these injections, discuss with your doctor the risks and benefits of these procedures for your specific condition.

Surgical Treatment

It is uncommon for people with only cervical spondylosis and neck pain to be treated with surgery.

Surgery is reserved for patients who have severe pain that has not been relieved by other treatment. Some patients with severe pain will unfortunately not be candidates for surgery. This is due to the widespread nature of their arthritis, other medical problems, or other causes for their pain, such as fibromyalgia.

In some cases, cervical spondylosis may lead to compression of the spinal cord or nerve roots resulting in neurological dysfunction and progressive deterioration. Although this is relatively rare, surgery is required in such a situation to remove compression from the nerve tissue (spinal cord and/or nerve roots) and to restore stability to the cervical spine.

Surgery, depending on the situation, may be achieved through either an anterior (front), posterior (back) or combined approach. After relieving the spinal cord and/or nerve compression, the spine is reconstructed by placing bone between the involved vertebra and performing a spinal fusion. Special implants may also be placed to restore the stability of the spinal column and assist in healing of the spinal fusion.