At least once in their lives, about 80 percent of all Americans will experience lower back pain that can range from a dull, annoying ache to absolute agony. Lower back pain is one of the most common ailments in the U.S. On any given day, over 6.5 million Americans are under some sort of treatment for lower back pain.
Because many people are familiar with the term "slipped" disc, this problem is mistakenly believed to be the chief cause of lower back pain. In fact, protruding discs are responsible for only 5-10 percent of the cases. Actually, the term itself is inaccurate, because the disc does not slip at all; it bulges, ruptures or herniates.
In some cases, the tough tissues that contain the disc are weakened by injuries that allow the soft gel-like center to protrude. If the protrusion presses on a nerve root, pinching it against the bone, the result is pain in the area of the body served by that nerve.
The pain of a ruptured disc is usually sharp and sudden. Commonly, the pain will be passed along the course of the nerve compressed by the ruptured disc. A disc pressing on the sciatic nerve root causes sciatica, sending pain from the buttock down the leg and into the foot.
When a disc ruptures, the pad between the two vertebrae is gone, and the gradual wearing of the bone can also lead to arthritis. This can cause serious pain if the arthritic spurs of the vertebrae press on the nerve root. The pain will worsen as years go by without treatment.
What to do if you injure your back
If you injure your back and believe that the injury involves a disc, the first things to do are:
Lie down on a bed or couch in a comfortable position.
Use anti-inflammatory medication (aspirin, ibuprofen or prescription drugs).
Apply heat or cold, whichever feels better.
You should see a back care specialist to assess the injury. In addition to a complete medical history and physical exam, the doctor may order blood tests or x-rays. A disc, which is not calcified, cannot be seen on a normal x-ray but can be picked up easily on a CT or MRI scan.
Many ruptured discs will respond to bed rest, and physical therapy can help relieve any muscle spasms associated with a ruptured disc.
If the symptoms do not subside, surgery may be needed to remove some of the disc. The vast majority of people with lower back pain, even those with disc disease, will not need surgery. In general, surgery is only useful for these problems:
Disc displacement causing weakness and intractable pain
Painful (and abnormal) motion of one vertebra in relation to another
Narrowing of the spinal canal from overgrowth of bone (spinal stenosis)
Some cases in which misalignment of one vertebra on another leads to chronic and/or severe pain.
Henry Ford Department of Orthopaedics & Sports Medicine offers a variety of surgical options to relieve an injured disc. An orthopaedic surgeon specializing in back and spine care can help to determine which procedure is best for you.
Degenerative Disc Disease
Degenerative Disc Disease Degenerative disc disease can affect any part of the spine, although common sites are the lumbar (lower back) and cervical (neck) spine. Spondylosis is another term for degenerative disc disease.
Degenerative disc disease can result from trauma (either acute or chronic/repetitive), infection or the natural aging process. The process of degeneration of the spine may lead to local pain, stiffness and restricted activity.
On an x-ray, a doctor may see a narrower disc space (spinal stenosis) and some osteophyte (bony outgrowth of spur) formation. As people age, these changes tend to show up on the x-rays of most people.
Conservative non-surgical therapy for disc disease includes nonsteroidal anti-inflammatory medications and exercise programs to strengthen abdominal muscles and reduce lumbar lordosis (curvature). Surgery should be considered when medical management fails to relieve pain.
Treating a painful, deformed, or unstable spine may require fusion surgery to hold a portion of the spine permanently in a desirable position. A bone fusion must mature for several months before it is secure. During that time, your physician may recommend a device that is affixed to vertebrae (spinal bones) and implanted within the body.
Until the fusion is complete, it is usually necessary to wear a brace or plaster cast. Various types of implants are used depending on the problem that required the fusion, the patient's age, and the surgeon's judgment.
Sciatica
Sciatica is the inflammation of the sciatic nerve, which then passes between layers of the buttock muscles into the deep muscles of the back of the thigh. Sciatic pain usually starts in the buttocks and extends down the rear of the thigh and lower leg to the sole of the foot and along the outer side of the lower leg to the top of the foot. Pain may also be present in the lower back.
A primary cause of sciatica is a herniated or bulging lower lumbar intervertebral disc that compresses one of the nerve roots before it joins the sciatic nerve. Another cause of sciatica is the Piriformis syndrome. The piriformis muscle extends from the side of the sacrum to the top of the thighbone at the hip joint, passing over the sciatic nerve in route. When a short or tight piriformis is stretched, it can compress and irritate the sciatic nerve.
The primary treatment of sciatica is rest to allow the inflammation of the nerve to subside. In an effort to alleviate pain, various medications (such as analgesics and muscle relaxants) may be prescribed, or anesthetic agents may be injected into the area around the spinal cord. In cases that do not respond to such conservative measures, surgery may be necessary.
Recently, new surgical techniques, such as microsurgery and the percutaneous (through the skin without cutting, as with a needle) removal of disc fragments, have been used. So far, success at relieving pain and neurologic symptoms has been good. Not all individuals with disc problems, however, are suitable for this surgery.
Physical therapy under a doctor's supervision or prescription is often used to relieve the pain of sciatica. Many therapists advise their patients to overcome the effects of a ruptured disc by developing the core muscles (the four muscle groups that form at the waist) in order to provide a supportive column of muscle that will help keep the disc in place.
Spinal Stenosis
Spinal stenosis occurs when the spinal canal is narrowed or compromised, leaving inadequate room for the nerves. The causes of stenosis vary. The condition may be either congenital or due to spinal degeneration.
A few diseases can cause spinal stenosis. Among them are Paget's disease, a disease of unknown origin that causes abnormal growth and distortion of a number of different bones; and fluoridosis, due to excessive fluoride, which can thicken bones and contribute to stenosis when there is a pre-existing narrowing of the canal. In some cases, scarring and other post-surgical problems, like overgrowth of a spinal fusion, can lead to stenosis.
Spinal stenosis usually affects the elderly. Symptoms include substantial back pain with variable leg pain and weakness associated with walking. The pain may become increasingly severe with standing and walking, and can usually be relieved by a short period of rest.
Unlike disc disease and other kinds of backache with an intermittent course, spinal stenosis generally becomes progressively more painful over time. After a complete medical history and physical examination, your physician may suggest radiologic studies, such as x-rays or an MRI (magnetic resonance imaging).
Treatment of stenosis consists of rest, painkillers, anti-inflammatory medications, support from a corset or brace, and gradual appropriate exercise. The majority of patients with spinal stenosis can be successfully managed without surgery. If these treatments fail, surgery may be the answer. Using a procedure called decompression, an orthopaedic surgeon operates on the spine from the back and frees the nerve roots as they go out through their tunnel from the spinal canal through a smaller canal and into the legs. In some cases, spinal fusion is necessary.
