Low back pain ranks among the most common health issues affecting Americans today with the American Chiropractic Association reporting that 1/2 of all working Americans experience low back pain symptoms annually. It is estimated that people suffering from low back pain are spending nearly $50 billion each year addressing and attempting to resolve their condition. Many times they are wasting both time and money on unproven gimmicks. Furthermore 80% of the population will suffer a low back problem at some point in their lives which causes lost time from both work and family. Low back pain qualifies as the single leading cause of disability in the world are according to most treating physicians. Low back pain is the number one type of chronic pain experience in the nation today with nearly 27% of all Americans reportedly suffering from this type of chronic bodily pain. In addition to lower back pain, some patients also complain of upper, middle, and lower back discomfort with sciatic nerve involvement. Common causes of lower back discomfort include arthritis, degenerative disc disease, or muscular afflictions. Many times a neurosurgeon will need act like an orthopedist to try to figure out the exact cause of the pain.
Chronic low back pain
Chronic low back pain does not necessarily describe the duration of symptoms however it describes the waxing and waning of low back pain that persists over time and fails to improve with conservative management strategies. Chronic low back pain does not occur as a result of a simple isolated injury or short term muscle strain however it is a type of back discomfort that last for more than 90 days is generally associated with a substantially more serious condition or disease. Frequently, chronic low back pain results from an injury sustained early in life that never quite healed. There may be a disc herniation or a stress fracture that is relatively quiet occasionally but tends to flare up intermittently. People who don’t do exercise or remain active may find themselves paying the price for it later. In fact multiple journals document the fact that chronic low back pain does not seem to generally be associated with serious conditions like arthritis, cancer, fractures, or infection such as discitis.
Spinal stenosis is a condition that arises in the lower back which involves narrowing of the room available for the spinal cord. Below the L2 vertebral body, the cauda equina is present however this structure is comprised of floating nerve roots that do not handle pressure very well. Specifically referring to pressure which is chronic and progressive. Spinal stenosis is just that type of pressure. Disc herniations, facet arthropathy, and congenital stenosis all can lead to symptomatic narrowing and Typically in the low back people will notice symptoms in their body and legs area. Typically standing and walking are the most bothersome with pain, numbness, and tingling radiating down into the legs. Sitting down dramatically relieves the symptoms so there is really static compression of the nerve roots. In many cases epidural steroid injections work magnificently and many people will avoid surgery for years at a time. Some of my patients frequently spend the winter months in the south and then come back in the spring and need an epidural steroid injection. This is a type of maintenance therapy that is very helpful and very useful in keeping the off my table.
Herniated disc occurs when stress on the lumbar spine causes the gel-like nucleus pulposus to herniate through the tough and fibrous annulus fibrosis. There can be a bulging disc which means that nothing has actually come out of the disc space to directly impact the nerve roots. In other cases, a disc herniation happens causing excruciating pain, progressive numbness, and weakness. The difference between a bulging disc and a herniated disc may be a matter of semantics however in practice they are dramatically different in appearance. A bulging disc can cause symptoms of low back discomfort that may improve with conservative care and core strengthening. A disc herniation needs oral steroids, potentially injectable steroids, and frequently surgery because of the unbearable nature of the pain. If you think you may have a bulging or herniated disc you should make an appointment with our office.