It affects over 80% of adults and is the main reason why people visit a doctor. According to the Global Burden of Disease (a study published in the prestigious medical journal Lancet), back pain is one of the leading causes of disability.
What are the most common causes of lower back pain?
“The causes of pain in the lumbar region (in the lumbar spine) can be mechanical, organic and idiopathic and most if not all are related to the spine. “Spinal diseases can be either congenital, ie present at birth, or acquired, ie they appear later in the life of the patient”, explains Mr. Marios Lykissas, Assistant Professor of Orthopedics, Spine Surgeon, Director Metropolitan Hospital.
• The mechanical etiology of pain in the middle is caused by the movement of the spine and results from problems in structures of the spine, such as joints, intervertebral discs, vertebrae, ligaments and muscles
• Organic pain in the middle is attributed to diseases such as spinal cancer
• The idiopathic etiology of pain in the middle is pain the cause of which is unknown.
Mechanical causes of lower back pain
Sprains. Ligament injuries and muscle or tendon strains are the most common causes of lower back pain. They are often associated with excessive exercise or stress.
Degenerative disc disease (disc disease). Over time, the discs become thinner and weaker due to wear and tear. This makes them less able to absorb vibrations and they are more likely to crack in their periphery.
The disc herniation. The periphery of the intervertebral disc may show cracks over time. When this happens, the soft contents of the disc may escape to the tube through which the nerves pass. A herniated disc, as this pathology is called, can press on the nerve roots, causing symptoms such as pain, tingling, numbness or weakness in the area that is innervated by the respective nerve root.
Sciatica. This is the pain caused by the pressure of the sciatic nerve. The sciatic nerve starts at the lumbar spine and ends at the lower extremities through the buttocks.
Spondylolisthesis. This is a condition in which a vertebra slides forward, disrupting the alignment of the spine and, sometimes, compressing nerve roots. It is most commonly seen in the lumbar spine and is caused either by progressive disc degeneration or by a vertebral fracture (spondylolysis).
Spinal stenosis. This is a narrowing of the spinal canal through which nerves pass, resulting in pain in the waist and lower extremities. It is most often caused by a combination of other pathological conditions such as disc herniation and osteoarthritis of the spine. Spinal stenosis can occur in both the cervical spine and the lumbar spine. Lumbar spine stenosis is more common.
What are the treatments for back pain?
“The treatment of back pain is gradual and is done with either non-invasive, invasive or minimally invasive treatments. Most of the time the doctor will start with simpler treatments and, if necessary, will proceed to more aggressive approaches afterwards. It should be noted that many treatments take time to lead to the desired result “adds the doctor.
Non-invasive treatments
Medicines. Drugs are numerous and can be:
• Non-steroidal anti-inflammatory drugs
• Muscle relaxants
• Anticonvulsant drugs
• Opioids.
Physical therapy. Physiotherapy for lower back pain includes passive and active treatments that help the patient build muscle strength, improve spinal flexibility and range of motion, maintain proper posture and more. Physiotherapy sessions may include:
• Excercise
• Cold / heat
• Massage
• Percutaneous electrical nerve stimulation (TENS)
• Ultrasound.
Injections. Epidural steroid injection or a selective nerve block can provide short-term pain relief when the pain is mainly in the lower extremities.
Invasive treatments & minimally invasive treatments
Spine surgery is not necessary for most patients who have low back pain. The most common spine surgeries are:
Microdiscectomy. When a disc herniation causes severe symptoms such as severe and persistent pain or loss of sensation and strength, removal of the damaged part of the disc that presses on the nerve will lead to immediate remission of symptoms and prevent irreversible loss of muscle strength. In recent years, this operation is performed with a minimally invasive and bloodless technique through a small incision always with the help of a microscope.
The safety, efficacy, rapid recovery and low complication rate of microdiscectomy have established it as the surgery of choice in patients with disc herniation.
Petalectomy / Herniation. This is an operation in which the back of one or more vertebrae is removed to create more space for the nerves. In a similar procedure known as a puncture, a very small piece of bone is removed from the back of the vertebra.
These surgeries are now performed with bloodless minimally invasive techniques with small incisions and with the help of surgical navigation (O-Arm II and StealthStation S8 Surgical Navigation System).
Spinal fusion. During this operation, two or more vertebrae are permanently connected to each other to reduce excessive movement of the spine.
Spinal fusion is performed to correct spinal deformities or to restore the stability of the spine in cases of spinal stenosis, slippage, disc disease or disc herniation. Spinal ligation surgeries are performed with bloodless minimally invasive techniques and always with the use of surgical navigation (O-Arm II and StealthStation S8 Surgical Navigation System). In recent years, the Robels Excelsius GPS robotic system of Globus Medical has been added to the staff of the Hospital, which ensures the safety and accuracy that every surgeon seeks.
The robotic system:
• Reduces surgical time
• Significantly reduces blood loss and therefore no blood transfusion is required
• Ensures precise transdermal placement of implants
• Minimizes hospital stays
• Significantly reduces perioperative morbidity.
When does low back pain need urgent treatment?
While some cases of back pain will require immediate intervention, most cases are non-urgent and can be treated on a regular basis.
But when there are:
• Weakness, numbness in the lower extremities
• Loss of control of the bladder or bowel
Injury
• Fever or nausea
• Pain that interrupts sleep or the patient is a child, then the chance of surgery is high.
How can we prevent back pain?
Although we can not stop the aging of our body and spine or change our genetic makeup, lifestyle changes can help manage and prevent lower back pain.
Improving our physical condition. People who are not in good physical condition are more likely to develop back pain, due to the weak back and abdominal muscles that help support the waist.
Staying active. People who lead a sedentary lifestyle are more likely to be injured in their daily activities.
Losing weight. The greater the weight, the greater the pressure exerted on the lumbar spine. Being overweight or obese can cause chronic lower back pain.
Lifting heavy objects in the right way. Make sure you bend your knees when lifting weights from below so that your hips and knees do most of the work. We hold the load close to the chest while getting up.
Making the workplace as ergonomic as possible. If we do sedentary work, we make sure that our chair supports our waist well and our hips are at a right angle to the floor.
We do not use tobacco products. “Apart from all the other health problems caused by the use of tobacco, it can restrict the flow of blood and oxygen to the discs, as a result of which they degenerate faster,” concludes Mr. Lykissas.
Writes:
Mr. Marios Lykissas, Assistant Professor of Orthopedics,
Spine Surgeon, Director of the Metropolitan Hospital Spine Clinic
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