Archive for January 23, 2017

Low Back Pain

If you are experiencing low back pain, which is muscle tension or stiffness localized below the rib margin and above the inferior gluteal folds, with or without sciatica, you are not alone. Low back pain can be debilitating and painful.

The human lower back consists of 5 vertebrae in the lower part of the spine between the ribs and the pelvis. The bones that form the spine in your back are cushioned by small discs. These discs are round and flat, with a tough, outer layer that surrounds a jellylike material called the nucleus. Located between each of your vertebra in the spinal column, discs act as shock absorbers for the spinal bones. Thick band of tissues attached to the vertebrae hold the disc in place. Of the 31 pairs of spinal nerves and roots, 5 lumbar and 5 sacral nerve root pairs connect beginning in the area of your lower back.

Low back pain can be due to herniated disc, lumbar spinal narrowing or osteoarthritis. Identifying the nature of the cause of low back pain is made by a neurosurgeon based on your history, sensation or change in bodily function experienced by you, physical examination and the results of diagnostic studies, if necessary. Some low back pain can be treated conservatively and then undergo imaging studies if medication and physical therapy are ineffective.

Diagnostic studies include, computed tomography scan, discography, electromyography, nerve conduction studies, magnetic resonance imaging, myelogram, selective nerve root block, and x-rays.

Nonsurgical treatment options include physical therapy, back exercises, weight reduction, epidural steroid injections, nonsteroidal anti-inflammatory medications, rehabilitation and limited activity. These treatments are aimed at relieving the inflammation in the back and irritation of nerve roots. Usually 4 to 6 weeks of conservative therapy is recommended before considering surgery.

If low back pain occurs after a recent injury such as a car accident, a fall or sports injury, you should seek medical care immediately. If there are no neurological problems like numbness, weakness, bowel and bladder dysfunction, you will benefit by beginning conservative treatment at home for 2 to 3 days. You are given anti-inflammatory medications such as aspirin or ibuprofen and are asked to restrict strenuous activities for a few days.

If low back pain gets worse or does not improve after 2 to 3 days of home treatment, get evaluated through thorough neurological exam done by the neurologist to determine which nerve root is being irritated, as well as rule out other serious medical conditions. If there are clear signs that the nerve root is being compressed, medications can relieve the pain, swelling and irritation. Limitation of activities is advised, in the beginning. If these options do not provide relief within 2 weeks, it is time to consider diagnostic studies.

Surgery is necessary when conservative treatment for low back pain does not provide relief. You may be a candidate for surgery if, back and leg pain limits your normal activity or impairs your quality of life, if you develop progressive neurological deficits, such as leg weakness and/or numbness. If you experience loss of normal bowel and bladder functions you need surgery. If you have difficulty standing or walking, surgery must be given a thought. If medication and physical therapy are ineffective, surgery is indicated.

If surgery is a must, neurosurgeons have a variety of options available to help relieve pressure on the nerve roots. If there are several nerve roots and discs compressing the nerve roots and causing the pain or if there is degeneration and instability in the spinal column, the neurosurgeon may opt to fuse the vertebrae together with bone grafts and stabilize the vertebrae with instrumentation, including metal plates, screws, rods and cages. A successful fusion will prevent the disc from bulging or herniating again. Following a fusion procedure, you can gain mobility in the back, including the ability to bend over. One is more likely to experience more mobility after surgery than before. In addition, you may require postoperative physical therapy.

The benefits of surgery should always be weighed carefully against its risks. Although a large percentage of low back pain patients report significant pain relief after surgery, there is no guarantee that surgery will help every individual.


Posted January 23, 2017 by dranilj1 in Art Of Medicine

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