Low Back Pain

 

50-70% of human beings will experience low back pain at least once in their lifetime and 13-15% experience sciatica.

Different age groups have different common causes. For adults, the common causes of low back pain include spinal degeneration, intervertebral disc diseases, spondylolisthesis, spinal stenosis, trauma-like fracture, tumour metastasis, and infection.

However, one must not forget the possibility of referred pain which is not caused by spinal causes, e.g. abdominal aorta anerysm.

Patients with low back pain should seek orthopaedic care.

The orthopaedic surgeon will take a history and perform an examination for the patient. Depending on indications, further investigations include:

  • X-ray

  • CT scan and/or myelogram or with/ without contrast

  • MRI

  • Discogram

  • Facet/nerve root injection

  • Bone scan

  • Electrophysiological studies, etc

Treatment modalities for spinal back pain are:

  • Taking a brief period of rest

  • Medication

  • Physiotherapy

  • Orthosis e.g. corset

  • Occupational therapy

  • Back exercises

  • Surgery

Surgery is indicated in the following cases:

  1. Severe back pain or sciatica that cannot be relieved by non-surgical means

  2. Rapidly deteriorating neurology or troublesome neurologic claudication

  3. Spinal instability which are causing a problem

  4. Some cases of fractures

  • Spinal decompression for neural compression, e.g. discectomy, laminotomy, laminectomy

  • Sometimes spinal fusion is needed if the spine is unstable or discogenic pain. It can be anterior or posterior or combined spinal fusion

  • Disc replacement surgery is another option for disc diseases

  • Facet joint/ nerve root injection can relieve facet joint pain/ radiculopathy

  • Depending on the fracture pattern, spinal fracture may require vertebroplasty, kyphoplasty, spinal instrumentation with or without fusion, corpectomy and anterior spinal fusion, etc.

  • Of course, some surgery can be done with minimal invasive techniques.

The information on this website is for general educational purpose only.
Readers should consult their physician before considering treatment, and should not interpret their condition solely based on the information above.