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Lower Back Pain Treatment

Sri Balaji Hospital is Chennai’s prime destination for lower back pain diagnosis and treatment.
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Lower Back Pain and Lumbar Anatomy

Lower back pain is a prevalent and widespread concern affecting individuals of all age brackets. The primary causes often stem from mechanical issues attributed to lifestyle factors such as weakened back muscles, a sedentary way of life, and obesity, leading to strains in tendons/muscles or disc-related problems. Additional contributors include structural issues, age-related modifications to the spinal canal, and arthritis. Addressing lower back pain frequently involves a combination of physical therapy, medication, and rest. To proactively safeguard against these issues, maintaining an optimal weight and an active lifestyle are paramount.

Anatomy image of the Lumbar spine.

Anatomy of the Lumbar Spine

The lumbar spine, encompassing the five vertebrae labelled L1 to L5, constitutes the lower back region of your spine. Notably, these lumbar vertebrae are the largest in the human body.

The posterior aspect, or the back, of the lumbar spine, houses the spinal canal, a protective enclosure for the spinal cord.

Adjacent to each lumbar vertebra, both above and below, are resilient, gel-like structures referred to as discs, serving as effective shock absorbers.

Flanking either side of the lumbar vertebrae are robust back muscles, also known as para-spinal muscles. These muscles collaborate harmoniously with the spine, playing a pivotal role in providing structural support and stability to the entire body.

Symptoms and Associated Complications of Lower Back Pain

The onset of lower back pain can manifest either suddenly or gradually. When it occurs suddenly, it is often linked to strenuous activities like lifting heavy weights or sustaining an injury. Such instances typically respond well to rest, the application of an ice pack, and the use of muscle relaxant medications.

Conversely, when lower back pain develops gradually and progresses over time, accompanied by additional symptoms such as numbness, radiating pain to the lower limbs (sciatica), disruptions in urinary or bowel habits, or weakness in the lower limbs, it warrants immediate evaluation. Key symptoms associated with lower back pain include:

Stiffness
It makes it challenging to move or straighten the back. Transitions between positions, such as lying down to sitting or getting up from a seated position, may exacerbate the pain, accompanied by a noticeable decrease in the range of motion in the lower back or spine.
Posture problems
Individuals may adopt a "crooked" or bent posture in an attempt to alleviate even minimal discomfort.
Muscle spasms
In cases of sudden or acute strain, lower back muscles may experience uncontrollable contractions, leading to muscle spasms. These spasms can induce severe pain, aggravated by even the slightest movement of the spine, including during periods of rest.
01 Causes of Lower Back Pain
02 Diagnosing Lower Back Pain
03 Management of Lower Back Pain

Lower back pain can be attributed to various conditions, including but not limited to:

Strains and Sprains

Among the most common causes, back strains and sprains result from injuring tendons, ligaments, or muscles. Improper lifting or attempting to lift objects beyond the spine's capacity can lead to these injuries.

Fractures

Spinal fractures typically occur due to traumatic events such as road traffic accidents or falls from height. In some cases, fractures may occur without preceding trauma, particularly in individuals with certain metabolic or systemic diseases like osteoporosis or spondylolysis.

Disc problems

The soft, jelly-like discs between vertebrae act as shock absorbers. Discs may bulge, pressing on nerves and causing sciatica (radiating pain to the legs). Herniated discs, resulting from tears, can cause severe back pain without necessarily causing sciatica. With age, discs can degenerate, becoming flatter and become less effective as shock absorbers, leading to pain (degenerative disc disease).

Structural problems

Conditions like spinal stenosis involve the narrowing of the spinal canal, causing back pain and potential neurological deficits such as numbness, weakness, or sciatica. Spondylosis, Progressive age, vertebral instability, deformities like scoliosis or kyphosis, and disc bulges can contribute to stiffness, difficulty in movement, and pain.

Arthritis

Wear and tear of spinal joints, known as age-related arthritis, commonly causes lower back pain in the elderly. Secondary arthritis, such as ankylosing spondylitis or rheumatoid arthritis, can affect younger individuals, leading to spinal stenosis, nerve compression, and lower back pain.

Diseases

Conditions like infections, various types of cancer, and spine tumours can result in back pain. Additionally, pelvic inflammatory disease (in women), other pelvic problems, and kidney stones may mimic lower back pain.

Spondylolisthesis

This involves the displacement of vertebrae, either forward (anterolisthesis) or backward (retrolisthesis). Spondylolisthesis can cause low back pain, often exacerbated by movement, and may also lead to leg pain. Understanding and identifying the specific cause of lower back pain is crucial for effective diagnosis and management.

When you consult with our spine specialists, a meticulous diagnostic protocol will be followed to accurately identify the cause of your lower back pain and recommend the most appropriate course of treatment.

Analysis of your medical history

Our spine specialists prioritise a comprehensive understanding of your condition. Patiently listening to your detailed account, they aim to pinpoint incriminating factors in your symptoms. This thorough history-taking enables a nuanced analysis of potential causes and guides the selection of a treatment approach that minimises stress and maximises results.

Spinal Examination

Following the detailed history, our specialists conduct a thorough examination of your spine. This examination aims to assess the spine's condition and rule out the presence or extent of nerve involvement. The findings help guide the next steps, whether they involve further investigations or specific treatment options.

Spinal X-ray

A spinal X-ray provides our specialists with a direct view of the bony structure. This reveals any obvious defects such as deformities or fractures.

MRI of the spine

When nerve involvement is suspected or confirmed, an MRI scan provides a detailed view of nerve compression, its extent, and the level of compression. This imaging modality offers a comprehensive understanding of the spinal structures, which is particularly useful for assessing soft tissues.

CT Scan

In certain cases, a CT scan may be requested for enhanced accuracy. This imaging technique provides 3D representations of the spine, offering detailed insights into bone structures and, to a lesser extent than MRI, soft tissues.

Blood Tests

Blood tests can be instrumental in revealing underlying pathologies of the spine. These tests may include assessing bone strength, tumour markers for suspected tumours, or identifying causes of secondary arthritis such as rheumatoid arthritis or ankylosing spondylitis.

In the majority of cases, relief from lower back pain can be achieved through conservative measures, including ice, pain relievers, over-the-counter muscle relaxants, or rest. After a brief period of rest, gradual resumption of normal activities is typically encouraged to enhance blood flow to the affected area and maintain the musculature around the spine and the overall health of the bones.

Medications

Nonsteroidal anti-inflammatory drugs (NSAIDs) and muscle relaxants may be recommended to alleviate pain and inflammation. In severe cases, oral steroid medications may be prescribed for their potent anti-inflammatory effects.

Physiotherapy

Various therapeutic modalities, such as Intermittent Pelvic Traction (IPT), Interferential Therapy (IFT), Ultrasonic Therapy (UST), LASER therapy, and Short Wave Diathermy, can be employed to reduce spasm, inflammation, and pain in conjunction with medications.

Physical therapy (PT)

PT aims to strengthen muscles to provide support to the spine, improve flexibility, and prevent re-injury.

Hands-on Manipulation

Hands-on treatments can help soothe tight muscles, alleviate pain, and enhance alignment and posture. Chiropractic adjustments, massage therapy, and Osteopathic manipulation are options that may contribute to back pain relief and functional restoration.

Injections

Spinal injections, such as selective nerve root blocks or epidural steroid injections, can provide immediate pain relief in cases where non-interventional treatments are insufficient. Stem cell injections or platelet-rich plasma (PRP) have also shown beneficial effects in regenerating damaged discs and addressing spinal bone issues.

Vertebroplasty or Kyphoplasty

For stable spine fractures causing severe and prolonged pain, procedures like Vertebroplasty or Kyphoplasty, performed as daycare keyhole procedures, can be considered. These techniques aim to address compression and prevent spinal deformities from developing.

Surgery

Surgery is reserved for cases where conservative and non-operative approaches prove ineffective or when there is a risk of disease progression without surgical intervention.

Spine Surgery

You will require spine surgery under the following medical circumstances:
Herniated or Ruptured Discs
Bulging or protruding discs exert excessive pressure on the spinal cord, impacting sensory and motor functions in the affected spinal region. When conservative measures fail to address the pressure on the spinal cord, surgical intervention may be necessary.
Spinal Stenosis
As the spinal canal narrows, it compresses the spinal cord, leading to progressive neurological damage. Surgical intervention becomes necessary to alleviate the compression and prevent further neurological deterioration.
Spondylolisthesis
One or more lumbar spine bones slip out of place, causing narrowing of the spinal canal and resulting in cord compression with progressive motor and sensory damage. Surgical correction is recommended to address the dislocation, restore spinal stability, and prevent ongoing damage.
Unstable fractures
Fractures in one or more vertebrae pose a risk of spinal cord injury, potentially leading to partial or complete paralysis of the lower limbs. Surgical stabilisation is required to prevent further damage and facilitate healing.
Degenerative disc disease
Compression of the spinal cord occurs as a result of age-related disc damage. Surgical intervention may be considered when conservative methods are insufficient in managing symptoms and addressing compression.
Tumours
Tumours, whether extradural or intradural, may necessitate surgical intervention based on factors such as location, risk of progression or spread, and proximity to the spinal cord. Surgical excision might be recommended to manage tumours posing a threat to the spinal cord or showing a risk of progression.
Infections
Spinal infections, such as tuberculosis or bacterial, fungal, or viral infections, may pose a risk of invading the spinal cord or causing paralysis. Surgical intervention may be required for infections with the potential to impact the spinal cord or result in complete paralysis.

Types of Spinal Surgeries

Microscopic Laminectomy/Spinal Decompression icon.
Microscopic Laminectomy/Spinal Decompression

Addressing compressed spinal cords, this surgery, known as posterior spinal decompression, involves a meticulous approach to decompressing the spinal cord from the posterior aspect.

Microscopic Discectomy icon.
Microscopic Discectomy

Specialising in removing the compressing surface of the disc, this surgery is often combined with laminectomy for optimal outcomes, ensuring comprehensive relief.

Foraminotomy icon.
Foraminotomy

Tailored for cases where compression affects a specific nerve root rather than the entire spinal cord, this surgical procedure focuses on widening the passage through which the nerve root exits the spinal canal, promoting enhanced spinal health.

Spinal Fusion icon.
Spinal Fusion

When diseases or their treatments threaten spinal stability, spinal fusion emerges as a crucial intervention. This procedure involves securing the lumbar spine using advanced techniques such as screws, bone grafts, and rods to fortify and stabilise the affected area, preventing or mitigating spinal instability.

Lumbar Spine Surgery Care

For lumbar spine surgeries, we commonly use general anaesthesia to ensure the patient's comfort and safety throughout the procedure.
01 Preoperative Evaluation
02 Postoperative Period
03 Expected Results One Week Post-Surgery
04 Expected Results Two Weeks Post-Surgery

Before surgery, our dedicated team of anesthesiologists and cardiologists conducts a thorough assessment of each patient's suitability for both anaesthesia and surgery. In the presence of any additional medical conditions, we collaborate with relevant specialists to secure their input and clearance for the anaesthesia/surgery.

Following the protocols at Sri Balaji Hospital, our spine surgery patients are encouraged to walk on the day of the surgery or, at the latest, by the following day. They will be able to use the restroom independently on the same day with the support of a walker. Discharge timelines vary based on the surgery type – patients undergoing microscopic surgery typically return home on the same day or within two days post-surgery, feeling completely pain-free. For those undergoing spinal fixation with rods and screws, discharge occurs typically between the third and fifth day.

You may return home and independently carry out your daily activities.

At the two-week mark, patients undergo suture (stitch) removal, marking a significant step in their recovery journey. By this time, patients continue to gain independence, being capable of restroom use and self-administered baths, fostering a sense of self-sufficiency and well-being.

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