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Lower Back Pain

Back pain is different for each person. The pain can have a slow onset or come on suddenly. The pain may be intermittent or constant. In most cases, back pain resolves itself within a few weeks. Almost everyone will experience low back pain at some point in their lives. This pain can vary from mild to severe. It can be short-lived or long lasting. However it happens, lower back pain can make many everyday activities difficult.

Lower Back Pain Causes
There are many causes of lower back pain. It sometimes occurs after a specific movement, such as lifting or bending. Aging also plays a role in many back conditions. The pain may result from disc injury, disc herniation, disc degeneration, degenerative spondylolisthesis, spinal stenosis, spinal scoliosis or other issues.

Disc Injury
Small tears to the outer part of the disc sometimes occur with aging. Some people with disc tears have no pain at all. Others have pain that lasts for weeks, months or even longer. A small number of people may develop constant pain that lasts for years and is quite disabling.

Herniated Disc
Another common type of disc injury is a "slipped" or herniated disc. A disc herniates when its jelly-like center (nucleus) pushes against its outer ring (annulus). If the disc is very worn or injured, the nucleus may squeeze all the way through.

When the herniated disc bulges out toward the spinal canal, it puts pressure on the sensitive spinal nerves, causing pain. Because a herniated disc in the low back often puts pressure on the nerve root leading to the leg and foot, pain often can occur in the buttocks and down the legs.

Herniated Disc Causes
With age, intervertebral discs begin to wear and shrink. In some cases, they may collapse completely and cause the facet joints in the vertebrae to rub against one another. This "wear and tear" on the facet joints is referred to as osteoarthritis, which can lead to further back problems, including spinal stenosis.

Changes from aging and general wear and tear make it hard for joints and ligaments to keep the spine in the proper position. The vertebrae move more than they should, and one vertebra can slide forward on top of another. If too much slippage occurs, the bones may begin to press on the spinal nerves.

Spinal Stenosis
Spinal stenosis occurs when the space around the spinal cord narrows and puts pressure on the cord and spinal nerves.

When intervertebral discs collapse and osteoarthritis develops, your body may respond by growing new bone in your facet joints to help support the vertebrae. Over time, this bone overgrowth—called spurs—can lead to a narrowing of the spinal canal. Osteoarthritis can also cause the ligaments that connect vertebrae to thicken, which can narrow the spinal canal.

Scoliosis
This is an abnormal curve of the spine that may develop in children, most often during their teenage years. It also may develop in older patients who have arthritis. This spinal deformity may cause back pain, and possibly leg symptoms, if pressure on the nerves is involved.

Lower Back Pain Symptoms
Back pain varies. It may be sharp, stabbing, dull, achy or feel like a cramp. The type of pain you have will depend on the underlying cause of the back pain.

Lower Back Pain Treatment
A doctor will examine the back and make any necessary arrangements for diagnostic testing. This will include looking at your back and pushing on different areas to find the source of the pain.

Your doctor may measure the nerve function in your legs. This includes checking your reflexes at your knees and ankles, as well as strength testing and sensation testing. This might tell your doctor if the nerves are seriously affected. Imaging tests, such as X-rays, MRIs, CAT scans, bone scans and bone density tests, may be ordered.

Non-Surgical Treatment of Lower Back Pain
Two main methods of non-surgical treatment exist. These include medication and physical therapy. Medications and therapeutic treatments combined often relieve pain enough for you to do all the things you want to do.

Non-steroidal anti-inflammatory medicines such as aspirin, naproxen and ibuprofen can reduce pain and swelling with few side effects. Narcotic pain medications, such as codeine or morphine, may help also help, but require a prescription. Steroids, taken either orally or injected into your spine, deliver a high dose of anti-inflammatory medicine.

Physical Therapy
Active therapy consisting of stretching, weight lifting and cardiovascular exercises can help restore motion while strengthening the lower back. More importantly, active therapy has also been shown for pain relief. Gwinnett Medical Center’s Glancy Rehabilitation Center has active therapy specialists trained in helping people with lower back pain.

Surgical Treatment of Lower Back Pain
Surgery for lower back pain should only be considered when non-surgical treatment options have been tried and have failed. It is best to try non-surgical options for six months to a year before considering surgery. In addition, surgery should only be considered if you doctor can pinpoint the source of your pain.

Surgery is not a last resort treatment option. Some patients are not candidates for surgery even though they have significant pain and other treatments have not worked. Some types of chronic low back pain simply cannot be treated with surgery.

Spinal Fusion
The basic idea is to fuse together the painful vertebrae so that they heal into a single, solid bone. Spinal fusion eliminates motion between vertebral segments. It is an option when motion is the source of pain. For example, your doctor may recommend spinal fusion if you have spinal instability, a bad curvature (scoliosis), or severe degeneration of one or more of your discs. The theory is: If the painful spine segments do not move, they should not hurt.

The surgery can be done through your abdomen, side, back or a combination of all three. The results of spinal fusion for lower back pain vary. It can be very effective at eliminating pain, not work at all and everything in between. Full recovery can take more than a year.

Herniated Disc Replacement
This procedure involves removing the disc and replacing it with artificial parts. The goal of disc replacement is to allow the spinal segment to keep some flexibility and maintain more normal motion. The surgery is done through your abdomen, usually on the lower two discs of the spine.

If you suffer from lower back pain, let the Gwinnett Medical Center–Duluth help you. For a free physician referral to one of Atlanta’s top sports medicine doctors, please call 678-312-5000.