Neurological Disorders: Lower Back Pain

Introduction

Lower Back pain is one of the most frequent pain conditions managed by a neurologist, and can range in the intensity of symptom, from very mild to excruciating/debilitating, and the care of this condition may require a multidisciplinary approach including surgical options.

Types & classification

There are multitudinous causes and also varieties of ways of classifying this condition.

Depending upon the duration;

  • Acute &
  • Chronic
Although there is no full consensus in this regard, generally if this pain resolves within the first few months after its onset (e.g. 3 months) it is called as acute type and if it persists beyond this time duration then it is chronic type.

Depending on the structure from which the pain originates;

  • Primary &/li>
  • Secondary
Primary type means it originates from the structures within in the back itself, whereas secondary indicates the pain is referred from somewhere else and this usually comes from the kidneys or abdominal organs.

Primary type:

Related with spine & related structures;

• Vertebra
• Disc
• Ligaments
• Nerve roots
• Spinal cord coverings (meninges) etc

Non spine related

  • Back muscles
  • Ligaments
  • Skin
  • Subcutaneous tissue etc
Some important disease conditions causing back pain include;
  • Vertebral fracture/dislocation
  • Spinal stenosis
  • Disc herniation
  • Disc bulge
  • Annular tear
  • Ligament calcification
  • Primary tumors of spine (benign & cancers)
  • Spinal metastasis
  • Infections (e.g. osteomyelitis)
  • Osteoporosis
  • Scoliosis/kyphosis
  • Rheumatoid arthritis
  • Ankylosing spondylitis (bamboo spine) etc
The back pain in some patients may radiate downwards to the legs and it is called as radiculopathy or pinched spinal root (lumbar or lumbosacral radiculopathies), similar condition happening with neck and arms is called cervical radiculopathy. The radiating pain may also be accompanied with numbness and tingling (pins & needles) sensation in the legs or arms.

Diagnosis

The following tests are usually ordered (case to case basis);

• Imaging study of the back/spine (xray, CT or MRI)
• EMG/NCS (electromyography and nerve conduction study) if leg symptoms are present like radiating pain from the back, numbness, tingling (pins & needles), leg muscle weakness etc
• Blood tests if infections/inflammatory/rheumatologic/tumor causes are suspected (e.g. ESR/CRP, RA factor, ANA etc)
• Additional tests as necessary

Treatment for Lower Back Pain

These are the general treatment guidelines;

• Pain medications
• Muscle relaxants
• Physical therapy
• Epidural steroid shot
• Intrathecal pain pump
• Spinal cord stimulator
• Treatment for conditions like osteoporosis, osteoarthritis, tumors, traumas etc
• Surgical interventions like discectomy, spinal fusion, spinal decompression etc.



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