Overview
Low back pain affects up to 40% of the adult population. The most common causes of low back pain are lumbar strain or sprain.
Low back pain may also be caused by degenerative processes, including degenerative disc disease and facet joint syndrome (a type of low back pain characterised by stiffness and pain that increases when turning backwards), disc herniation, vertebral fractures, spinal stenosis (narrowing of the spinal canal) and spondylolisthesis (displacement of a vertebra or the vertebral column).
It is characterised by pain in your lower back which may spread to your hips, buttocks or thighs. Over 90% of low back pain and sciatica (pain caused by an irradiated or inflamed sciatic nerve) spontaneously disappear within 30 days after medical and physical therapy.
Symptoms
The location of your pain depends on the cause of the low back pain. If you have a vertebral compressive fracture, you will experience severe pain in the middle of your lower back which is made worse when pressure is applied or during movement.
If you have disc disease, your pain may be associated with sciatica, or if it is caused by facet joint pain your pain may increase when you twist or bend backwards, or if it is due to spinal canal stenosis or instability you may have pain due to the strain.
Diagnosis
There are a number of methods that your doctor can use to diagnose you, including taking a medical history, clinically examining you, or using X-ray, CT or MRI, although this latter is the most sensitive exam. Electromyography may be also used to assess the electrical activity of your skeletal muscles.
Treatment
In most cases, the first treatment option for patients is conservative treatment, including rest and non-steroidal anti-inflammatory drugs, physical therapy, and brace support for vertebral fractures. Steroid injections are generally proposed after a period of failure of conservative management.
There are also minimally invasive treatments available. Minimally invasive therapies include vertebroplasty or vertebral augmentation for vertebral fractures, disc decompression for contained disc herniation, thermal (radiofrequency ablation) denervation for facet joint syndrome and or screws for facet arthrodesis.
Patients report a 93% success rate for vertebroplasty, 79% for disc decompression and 75% for radiofrequency-based neurotomy, as measured by the amount of pain reduction experienced. If these treatments do not work for you, you may be advised to have surgery.