Low Back Pain
90% of low back pain occurs when a nerve that travels from the spinal cord through the bones of the spine is pinched or irritated. This results in the muscles of the back tensing up and causing the patient low back pain. The solution to this problem depends on why the nerve is irritated in the first place.
The spinal cord which arises in the brain is an intricate network of nerves, discs and bones. It is protected by the spinal column as it runs down the back. All our body movements are controlled by the spinal cord. The nerves that run out of the spinal cord to control our movements are called the motor nerves.
Nerves that run from the spinal cord to the brain are the sensory nerves and they take messages from the body back to the brain. Together, both the motor and sensory nerves form more than 50 nerve roots, which run through holes called foramina, in the bones of the spinal column. Each one of these nerves roots can potentially cause a problem.
The spinal cord is protected by a soft, flexible disc that separates each bone (vertebrae) in the spine. This disc acts as a shock absorber. The outside rim of the disc is rigid, but the inside is soft and gel-like. Any sort of activity, stress or a mechanical problem in the spine can cause a disc to bulge. The bulging disc may put pressure on a nerve root causing low back pain or leg pain in the patient.
In more severe cases, the disc bulge may cause disc rupture or herniation putting even greater pressure on the nerve root. The nerve roots of the lower back cause not only back pain but also pain that radiates down one or both legs. There may also be muscle weakness, numbness and changes in reflexes in the legs. The key to treatment is to relieve nerve irritation. Although low back pain can be quite debilitating and severe, in 90% of patients, the condition improves without surgery. However, 50% of these patients will have a recurrent episode within one year.
If low back pain occurs acutely because of a recent, specific injury, e.g., a car accident, you should consult a Doctor immediately. Otherwise, you could try conservative treatment for 2-3 days. The suggestion is to take an anti-inflammatory medicine like ibuprofen and restrict activity for a few days. If the back pain does not improve see your doctor. If conservative treatment does not help, you may have to consider surgery.
The Aging Spine
Our spine also ages just like the rest of our body. As we age, our bodies dehydrate (lose water) and in the spine this causes the discs that cushion and separate our vertebrae to dry out. They become less effective as shock absorbers. The ligaments and bones in the spinal cord also become pliable (or flexible). This results in narrowing of the spinal canal which is called stenosis. In some of us, this narrowing can compress the nerve roots in the lower back causing back pain and other symptoms when standing or walking. This condition is very treatable. If conservative treatment (anti-inflammatory medication, limited activity, physiotherapy) fails, surgery needs to be considered.
An MRI of the lumbar-sacral spine helps the neurosurgeon determine the diagnosis and severity of the problem. The findings of the MRI are compared with the patients symptoms before the neurosurgeon considers a procedure.
Is Surgery Recommended?
Neurosurgeons who have been trained in the US, have throughout their 7-year residency program been trained on all treatment options available for diseases of the spine and can therefore determine the best treatment option for a particular spine condition. Spinal surgery involves operating in the region of the spinal cord and the nerves, and therefore precision and delicacy are the keys to a successful and safe procedure. Neurosurgeons unlike orthopedic surgeons often use an operating microscope to help magnify the nerves and discs. This allows for greater precision and a smaller incision. After any type of spine surgery, it is important that patients continue to work with their neurosurgeons on a rehabilitation program which includes physical therapy, medications and reduced activity.