Article from City Hospital at White Rock
Eighty percent of adults will suffer from lower back pain during their lifetime according to an epidemiology study published by the National Institutes of Health. Lower back pain is the second-most common cause of job-related disability and time off of work. Most chronic sufferers turn to medications, heating pads, and massage to relieve their aches, but when is the right time to see an orthopedic surgeon?
Do you suffer from lower back pain? You’re not alone. In this guide, we will discuss the common causes of lower back pain and how an orthopedic surgeon can help you.
Eight Risk Factors of Lower Back Pain
There are eight risk factors that can increase a person’s chances of developing lower back pain. These factors include:
- Age – Most patients experience lower back pain as they age. Osteoporosis can develop, leading to fractures. Additionally, spinal stenosis increases with age due to lost cushioning and reduced muscle elasticity in the vertebrae.
- Fitness – Out-of-shape people are more likely to develop back pain. Weak abdominal muscles create lack of support for the spine.
- Pregnancy – Pelvic changes caused by increased pregnancy weight gain can cause lower back injuries. This does not always resolve after childbirth.
- Obesity – Excess weight can cause back aches and pains.
- Genes – Inherited conditions can cause lower back pain. Ankylosing spondylitis, a genetic form of arthritis, can cause lower back pain as spinal joints fuse together.
- Job-related risks – Lifting and pushing heavy objects can cause injuries. Sedentary desk jobs can trigger back pain due to poor posture or back support.
- Mental illness – Anxiety and depression can alter how a person perceives pain. Chronic pain can also lead to the development of psychological issues that affect the body in several ways.
- Backpack overload – Heavy backpacks can strain younger children’s back muscles. Backpacks shouldn’t weigh more than 20 percent of the child’s body weight.
What is Lower Back Pain?
Lower back pain, or lumbago, affects more than three million people every year. The condition affects men and women equally. Patients can experience a dull ache or sharp stabbing pains that immobilize them.
There are two categories of back pain according to orthopedic surgeons:
- Subacute low back pain – This condition lasts four to 12 weeks and resolves with non-surgical intervention.
- Chronic back pain – This health issue extends three months or longer, even after the patient receives treatment for their initial injury. Around 20 percent of patients suffer from this chronic pain.
Nine Common Causes of Lower Back Pain
The National Institute of Neurological Disorders and Strokes is a federal agency that studies spinal and neurological related issues. The NINDS says there are nine leading causes for lower back pain.
- Disc degeneration – Healthy intervertebral discs are flexible, allowing people to bend. As a person ages, these discs deteriorate and lose their cushioning ability.
- Herniated and ruptured discs – Another common cause of lower back pain occurs when discs compress and bulge outward.
- Spinal nerve root injury (Radiculopathy) – These injuries cause inflammation that compresses the spinal nerve root. The patient experiences pain, numbness, or tingling that radiates down their limbs. Herniated or ruptured discs cause most spinal nerve root injuries.
- Sciatica – This spinal nerve injury develops when inflammation compresses the sciatic nerve. Patients experience a burning, shock-like pain in their lower backs, buttocks, and feet. They can also have numbness, muscle weakness, and interruption in nerve signaling. Tumors, cysts, or injuries may cause sciatica.
- Skeletal irregularities – Some people develop spinal curvatures as they age. Skeletal irregularities (lordosis) is an abnormal arch of the lower back. Congenital spinal disorders can cause these abnormalities.
- Spondylolisthesis – This disorder occurs when an injury causes the lower spine’s vertebrae to slip out of place. The displaced discs irritate and pinch nerves exiting the spinal column.
- Sprain and strains – These injuries trigger most acute back pain. Sprains occur due to muscle strains, overstretching, or tendon and ligament tears.
- Spinal stenosis – The condition develops when the spinal column narrows, placing pressure on the spine and nerves. Patients with spinal stenosis suffer from numbness, leg weakness, and sensory loss.
- Traumatic injuries – High-impact events (during sports, car accidents, or falls) can cause intervertebral discs to herniate or rupture.
Uncommon Causes of Lower Back Pain
The NINDS has identified nine uncommon causes of lower back pain.
- Infections – Infections of the vertebrae can cause pain. These conditions include osteomyelitis, discitis, and sacroiliitis.
- Tumors – Cancerous masses can trigger lower back pain.
- Cauda equina syndrome – This rare complication results from ruptured disks. Their material pushes out into the spinal column, then compresses the lumbar and sacral nerve roots. Cauda equina syndrome causes patients to lose bladder and bowel control. It may result in permanent damage if not treated.
- Abdominal aortic aneurysms -This dangerous health disorder causes the abdominal vessel supplying blood to the lower body to swell. Severe back pain can signal that the aneurysm is large enough to rupture. This condition requires immediate medical attention.
- Kidney stones – Patients with this issue suffer from sharp, lower back pains on one side.
- Arthritis – These disorders include osteoarthritis, rheumatoid arthritis, and other inflammatory joint diseases.
- Osteoporosis – This progressive metabolic bone disorder causes vertebral fractures and decreases in bone density and strength.
- Endometriosis – Tissue can leave the uterus and migrate to other areas, causing lower back pain.
- Fibromyalgia – This disease causes chronic pain, soreness, and fatigue.
Step One: Before You Visit a Surgeon, See Your Family Doctor
Every patient should visit their primary care physician before seeing an orthopedic spine surgeon. Your family doctor will perform a medical exam to identify the cause of your condition. He or she can prescribe medicines for non-chronic lower back pain (12 weeks and less). These treatments may include analgesics, non-steroidal anti-inflammatory drugs, anticonvulsants, and counter-irritants.
Additionally, your doctor can order chiropractic care or physical therapy as a first-line treatment option. Chiropractors are specialists that use spinal manipulation and mobilization to provide pain relief. Physical therapists use techniques including traction, massage, muscle manipulation, and biofeedback to relieve aches and mobility issues. These therapies may not alleviate your pain. If this happens, your primary care doctor will refer you to an orthopedic surgeon. Contact an experienced orthopedic surgeon who can diagnose your lower back pain..
Step Two: Visit an Orthopedic Doctor
Orthopedic surgeons diagnose disorders of the bones, joints, muscles, ligaments, and tendons. These professionals may use the following tests to develop a treatment plan for you.
- X-ray – This imaging technique identifies broken bones and injured vertebra. It can also reveal structural and vertebral misalignments or fractures.
- Computerized tomography (CT) – This imaging helps orthopedic surgeons identify soft tissue damage that may be causing your pain. CT can reveal bulging discs, spinal stenosis, disc ruptures, tumors, and other health conditions.
- Myelograms – These enhance the x-ray and CT scan images. Technicians inject a contrast dye into the spine, allowing any spinal and nerve compression to be seen on other examinations.
- Discography – Surgeons use these diagnostic procedures when other test fails to find the cause of lower back pain. Doctors inject a contrast dye into the spinal area where the lower back issue exists. The fluid pressure will reproduce the symptoms to identify the damaged discs. The information helps patients who require lumbar surgery after conventional treatments have failed.
- Magnetic Resonance Imaging (MRI) – Physicians use a magnetic force to produce images of soft tissue, muscles, tendons, and blood vessels.
- Electrodiagnostic – These procedures include electromyography, nerve conduction studies, and evoked potential studies. They can detect muscle weaknesses resulting from nerve issues.
- Bone scans – Orthopedist use bone scans to detect and monitor infections, orthopedic disorders, and fractures. Doctors inject a tiny amount of radioactive material and allow it to collect in the bones. Afterward, they photograph images to identify any bone metabolism irregularities.
- Ultrasound (Sonography) – The test uses high-frequency sound waves to image the inside of the body. This test can show ligament, muscle, and tendon tears.
- Blood tests – The screenings can identify infection, inflammation, and arthritis.
Non-Surgical Treatments Orthopedic Surgery
Your orthopedic surgeon may offer several non-surgical treatments to alleviate your pain, before recommending surgical options. They include the following:
- Nerve block therapies – An orthopedic doctor can use local anesthetics, botulinum toxins, or steroids to block nerve pain. An orthopedist’s skill determines whether this approach is successful. They must know how to identify and treat the right nerves. Additionally, physicians may inject low doses of pain relievers (using a catheter) to block, nerve pain.
- Epidural steroid injections – Orthopedic surgeons use this short-term treatment option to relieve sciatica-related, low-back pain. The NINDS doesn’t recommend this treatment method for spinal stenosis patients, because most experience poor long-term outcomes.
- Transcutaneous electrical nerve stimulation (TENS) – Battery-powered electrodes generate impulses that block pain peripheral nerves pain. TENS also elevates endorphins, the body’s pain-numbing chemicals. Recent studies have shown TENS produces mixed results.
Surgical Treatment Options
An orthopedic doctor will consider surgery when other treatments fail to relieve pain. It can take months for a patient to fully heal after a surgical procedure.
Operations aren’t always effective, so patients must consider the risks before undergoing a procedure. Here are nine surgical options for patients.
- Vertebroplasty and Kyphoplasty – Orthopedic surgeons use this minimally invasive procedure to treat compression fractures caused by osteoporosis. They insert a hypodermic needle into the vertebrae’s largest region, then fill it with bone cement. Once the material hardens, it relieves pain and stabilizes the area. Surgeons prepare patients for vertebroplasties using kyphoplasty. They gently inflate a balloon to restore the vertebrae’s height before they inject the cement.
- Spinal decompression (laminectomy)– Specialists perform this operation to treat spinal stenosis. They remove any bone spurs and portions of the vertebral walls (lamina). Decompression relieves spinal column pressure.
- Discectomy or microdiscectomy – This operation removes herniated discs pressing against the spinal column’s nerves. During a microdiscectomy, doctors eliminate the herniation disc using a small back incision. Laminectomies and discectomies are usually performed together.
- Foraminotomy – Bulging discs can narrow the spinal cord. This inflammation causes pain, numbness, and limb weakness. Physicians widen the bony hole (foramen) where the nerve root leaves the spinal canal to relieve pressure.
- Intradiscal electrothermal therapy – IDET treats bulging and cracked discs caused by degenerative disc disease. Doctors insert a catheter through an incision into the damaged area. They pass a wire through it, then apply a heated, electrical current. The procedure strengthens collagen fibers, reduces bulging, and decreases spinal irritation. Researchers are still assessing the efficacy of IDET.
- Nucleoplasty, or plasma disc decompression (PPD) – Orthopedic surgeons use radiofrequency to treat herniated discs. They insert a heated needle to guide a plasma laser into the area. The laser vaporizes damaged disc tissue and reduces nerve pressure and inflammation.
- Radiofrequency denervation – Doctors disrupt the nerves’ conduction of signals to lower pain. Specialists use x-rays to identify specific nerves, then apply a local anesthetic to identify the ones causing pain. They heat the region to destroy the nerves. This procedure produces temporary pain relief.
- Spinal fusion – During this procedure, physicians remove vertebrae to alleviates pain caused by degenerative disc disease (spondylolisthesis). Doctors perform the procedure using an incision in the abdomen (called anterior lumbar interbody fusion) or the back (posterior fusion). After removing the damaged areas, surgeons fuse adjacent vertebrae using bone grafts and metal devices. Patients lose some spinal flexibility after surgery. They need a long recovery period so the vertebrae can graft together.
- Artificial disc replacement – This surgery treats people with severe disc damage. They remove the disc, then replace it with synthetic bone to restore the vertebrae’s height and movement.
New Mexico Orthopaedics is a multi-disciplinary orthopaedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.
New Mexico Orthopaedics offers a full spectrum of services related to orthopaedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.
Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopaedic condition, and offer related support services, such as physical therapy, WorkLink and much more.
If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.