article byPedra Branca Municipal Hospital
Eighty percent of adults will experience low back pain in their lifetime, according to an epidemiological study published by the National Institutes of Health. Low back pain is the second most common cause of work-related disability and absence from work. Most chronic patients turn to medications, heating pads and massage to relieve pain, but when is the right time to see an orthopedic surgeon?
Do you suffer from lower back pain? Not alone. In this guide, we'll discuss common causes of lower back pain and how an orthopedic surgeon can help you.
Eight risk factors for low back pain
There are eight risk factors that can increase a person's chances of developing low back pain. These factors include:
- Age– Most patients experience lower back pain as they age. Osteoporosis can develop, leading to fractures. Also, spinal stenosis increases with age due to loss of cushioning and reduced muscle elasticity in the vertebrae.
- Physical aptitude– People who are out of shape are more likely to develop back pain. Weak abdominal muscles create a lack of support for the spine.
- the pregnancy– Pelvic changes caused by weight gain during pregnancy can cause lower back injuries. This does not always resolve after delivery.
- Obesity– Excess weight can cause back pain and discomfort.
- genes– Hereditary conditions can cause lower back pain. Ankylosing spondylitis, a genetic form of arthritis, can cause pain in the lower back when joints in the spine fuse together.
- Work-related hazards– Lifting and pushing heavy objects can cause injuries. Sedentary desk jobs can trigger back pain due to poor posture or back support.
- Mental disease– Anxiety and depression can alter the way a person perceives pain. Chronic pain can also lead to the development of psychological problems that affect the body in many ways.
- backpack overload– Heavy backpacks can strain the back muscles of younger children. Backpacks must not weigh more than 20 percent of the child's body weight.
What is Low Back Pain?
Low back pain, or lumbago, affects more than three million people each year. The condition affects men and women equally. Patients may feel a dull ache or sharp pains that immobilize them.
There are two categories of back pain according to orthopedic surgeons:
- subacute low back pain– This condition lasts from four to 12 weeks and resolves with a non-surgical intervention.
- chronic back pain– This health problem lasts for three months or more, even after the patient receives treatment for the initial injury. About 20% of patients suffer from this chronic pain.
Nine common causes of lower back pain
HeNational Institute of Neurological Disorders and Strokeis a federal agency that studies spinal and neurological issues. NINDS says there arenine main causesfor low back pain.
- disc degeneration– Healthy intervertebral discs are flexible, allowing people to bend. As a person ages, these discs deteriorate and lose their cushioning ability.
- Hernias and ruptured disks– Another common cause of lower back pain occurs when the discs are compressed and bulge.
- Spinal nerve root injury (radiculopathy)– These injuries cause inflammation that compresses the spinal nerve root. The patient feels pain, numbness or tingling that radiates to the extremities. Herniated or ruptured discs cause most spinal nerve root injuries.
- Sciatica– This spinal nerve injury develops when inflammation compresses the sciatic nerve. Patients experience burning, shock-like pain in the lower back, buttocks, and feet. They may also have numbness, muscle weakness, and disruption in nerve signaling. Tumors, cysts or injuries can cause sciatica.
- skeletal irregularitys – Some people develop spinal curvatures as they age. Skeletal irregularities (lordosis) are an abnormal arch of the lower back. Congenital disorders of the spine can cause these abnormalities.
- spondylolisthesis– This disorder occurs when an injury causes the vertebrae in the lower spine to move out of place. Slipped discs irritate and compress the nerves exiting the spine.
- sprains and strains– These injuries trigger the most acute back pain. Sprains occur due to muscle strains, overstretching or ruptures of tendons and ligaments.
- spinal stenosis– The condition develops when the spine narrows, putting pressure on the spine and nerves. Patients with spinal stenosis suffer from numbness, leg weakness and sensory loss.
- traumatic injuries– High-impact events (during sports, car accidents, or falls) can cause intervertebral discs to herniate or rupture.
Unusual causes of low back pain
NINDS identified nine uncommon causes of low back pain.
- infections– Infections of the vertebrae can cause pain. These conditions include osteomyelitis, discitis, and sacroiliitis.
- tumors– Cancerous masses can trigger lower back pain.
- caeda equina syndrome– This rare complication results from ruptured disks. Its material pushes the spine upward and then compresses the lumbar and sacral nerve roots. Cauda equina syndrome causes patients to lose bladder and bowel control. It can result in permanent damage if left untreated.
- abdominal aortic aneurysms-This dangerous health disorder causes the abdominal vessel that supplies blood to the lower body to swell. Severe back pain could indicate that the aneurysm is big enough to rupture. This condition requires immediate medical attention.
- kidney stones– Patients with this problem suffer from sharp pain in the lower back on one side.
- Arthritis– These disorders include osteoarthritis, rheumatoid arthritis, and other inflammatory joint diseases.
- osteoporosis– This progressive metabolic bone disorder causes vertebral fractures and decreased bone density and strength.
- endometriosis– Tissue can leave the uterus and migrate to other areas, causing lower back pain.
- fibromyalgia– This disease causes chronic pain, discomfort and fatigue.
Step One – Before visiting a surgeon, consult your GP
All patients should consult their primary care physician before seeing an orthopedic spine surgeon. Your GP will perform a medical examination to identify the cause of your condition. He or she may prescribe medication for non-chronic low back pain (12 weeks or less). These treatments may include analgesics, nonsteroidal anti-inflammatory drugs, anticonvulsants, and counter-irritants.
In addition, your doctor may order chiropractic care or physical therapy as a first-line treatment option. Chiropractors are specialists who use spinal manipulation and mobilization to relieve pain. Physical therapists use techniques that include traction, massage, muscle manipulation, and biofeedback to alleviate pain and mobility issues. These therapies may not relieve your pain. If this happens, your primary care physician will refer you to an orthopedic surgeon. Get in touch with an experienced orthopedic surgeon who can diagnose your lower back pain.
Step two: Visit an orthopedic doctor
Orthopedic surgeons diagnose disorders of the bones, joints, muscles, ligaments and tendons. These professionals can use the following tests to develop a treatment plan for you.
- bone scan– This imaging technique identifies broken bones and injured vertebrae. It can also reveal structural and vertebral misalignments or fractures.
- Computed Tomography (CT)– This image helps orthopedic surgeons identify soft tissue damage that may be causing your pain. CT scans can reveal bulging discs, spinal stenosis, ruptured discs, tumors and other health conditions.
- myelogram– Improve X-ray and CT images. Technicians inject a contrast dye into the spine, allowing any compression of the spine and nerves to be seen on further scans.
- Discography– Surgeons use these diagnostic procedures when other tests cannot find the cause of low back pain. Doctors inject a contrast dye into the area of the spine where the lower back problem exists. Fluid pressure will reproduce symptoms to identify damaged discs. The information helps patients who need lumbar surgery after conventional treatments fail.
- Magnetic Resonance Imaging (MRI)– Doctors use a magnetic force to produce images of soft tissues, muscles, tendons and blood vessels.
- electrodiagnosis– These procedures include electromyography, nerve conduction studies, and evoked potential studies. They can detect muscle weakness resulting from nerve problems.
- bone scans– Orthopedists use bone scans to detect and monitor infections, orthopedic disorders and fractures. Doctors inject a small amount of radioactive material and allow it to build up in the bones. They then photograph images to identify any irregularities in bone metabolism.
- Ultrasound (Echography)– The test uses high-frequency sound waves to make images of the inside of the body. This test can show ligament, muscle, and tendon tears.
- blood test– Tests can identify infection, inflammation and arthritis.
Non-Surgical Treatments Orthopedic Surgery
Your orthopedic surgeon can offer several non-surgical treatments to ease your pain before recommending surgical options. They include the following:
- Nerve block therapies– An orthopedic doctor may use local anesthetics, botulinum toxins or steroids to block nerve pain. An orthopedist's skill determines whether this approach is successful. They must know how to identify and treat the correct nerves. In addition, doctors may inject low doses of pain relievers (through a catheter) to block nerve pain.
- epidural steroid injections– Orthopedic surgeons use this short-term treatment option to relieve lower back pain related to sciatica. NINDS does not recommend this method of treatment for patients with spinal stenosis because most have poor long-term outcomes.
- Transcutaneous electrical nerve stimulation (TENS)– Battery-powered electrodes generate pain-blocking impulses from peripheral nerves. TENS also increases endorphins, the body's pain-killing chemicals. Recent studies have shown that TENS produces mixed results.
Surgical Treatment Options
An orthopedic doctor will consider surgery when other treatments do not relieve pain. It can take months for a patient to fully heal after a surgical procedure.
Operations are not always effective, so patients should consider the risks before undergoing a procedure. Here are nine surgical options for patients.
- Vertebroplastia e Cifoplastia– Orthopedic surgeons use this minimally invasive procedure to treat compression fractures caused by osteoporosis. They insert a hypodermic needle into the largest region of the vertebrae and then fill it with bone cement. Once the material hardens, it relieves pain and stabilizes the area. Surgeons prepare patients for vertebroplasty using kyphoplasty. They gently inflate a balloon to restore height to the vertebrae before injecting the cement.
- Decompression of the spine (laminectomy)– Specialists perform this operation to treat spinal stenosis. They remove any bone spurs and parts of the vertebral walls (lamina). Decompression relieves pressure on the spine.
- Discectomia ou microdiscectomia– This operation removes the herniated discs that press on the nerves in the spine. During a microdiscectomy, doctors remove the herniated disc through a small incision in the back. Laminectomies and discectomies are usually done together.
- foraminotomia– Bulging discs can narrow the spinal cord. This inflammation causes pain, numbness, and weakness in the extremities. Doctors widen the bony opening (foramen) where the nerve root exits the spinal canal to relieve pressure.
- intradiscal electrothermal therapy– IDET treats bulging and cracked discs caused by degenerative disc disease. Doctors insert a catheter through an incision in the damaged area. They run a wire through it and then apply a heated electrical current. The procedure strengthens collagen fibers, reduces bulging and decreases spinal irritation. Researchers are still evaluating the effectiveness of IDET.
- Nucleoplasty or Plasma Disc Decompression (PPD)– Orthopedic surgeons use radiofrequency to treat herniated discs. They insert a heated needle to guide a plasma laser into the area. The laser vaporizes damaged disc tissue and reduces nerve pressure and inflammation.
- Radiofrequency denervation– Doctors interrupt the conduction of nerve signals to reduce pain. Specialists use X-rays to identify specific nerves and then apply a local anesthetic to identify the ones causing pain. They heat the region to destroy the nerves. This procedure produces temporary pain relief.
- spinal fusion– During this procedure, doctors remove the vertebrae to relieve pain caused by degenerative disc disease (spondylolisthesis). Doctors perform the procedure through an incision in the abdomen (called anterior lumbar interbody fusion) or the back (posterior fusion). After removing the damaged areas, surgeons fuse the adjacent vertebrae together using bone grafts and metal devices. Patients lose some spinal flexibility after surgery. They need a long recovery period before the vertebrae can be grafted.
- artificial disc replacement– This surgery treats people with severe disc damage. They remove the disc and replace it with synthetic bone to restore height and movement to the vertebrae.
New Mexico Orthopedics is a multidisciplinary orthopedic clinic located in Albuquerque, New Mexico. We have several physical therapy clinics located throughout the greater Albuquerque area.
New Mexico Orthopedics offers a full range of services related to orthopedic care, and our experience ranges from acute conditions such as sports injuries and fractures to long-term chronic care diagnoses including total joint replacement and spinal disorders.
As our team of highly trained physicians specialize in various aspects of the musculoskeletal system, our practice has the ability to treat any orthopedic condition and offer related support services such as physical therapy, WorkLink and more.
If you need orthopedic care in Albuquerque, New Mexico, contact New Mexico Orthopedics at 505-724-4300.
What can an orthopedist do for back pain? ›
Using various methods for pain reduction, which include injections, medication, and physical therapy, orthopedic physicians can offer long-term relief from back pain. Many orthopedic physicians are also orthopedic surgeons.Who is the best professional to see for back pain? ›
“A physiatrist is the primary care doctor of the back,” he explains. Physiatrists are fully focused on diagnosis and non-surgical treatment of musculoskeletal (muscle and bone) issues, so they may have more specialized knowledge than a PCP.What are 2 things that an orthopedist can do for you? ›
Orthopedic surgeons can repair broken bones and injuries to muscles and tendons, among other things and help improve function and reduce or eliminate pain. They can also work in conjunction with other specialists such as therapists, rehabilitation doctors and pain management specialists to optimize treatment.Should you see a neurologist or orthopedist for back pain? ›
While an orthopedic doctor may work with injuries like broken bones, a neurologist is more likely to treat spinal injuries that may require surgery. In fact, only neurologists have the skill and ability to perform surgery in specific areas of the spine like the dura.Should you see an orthopedist for back pain? ›
Back pain can be mild, moderate, or severe. Usually, you can treat mild back pain at home. However, back pain that is severe is usually a sign of a serious health condition or injury. If your back pain is severe and is consistently interfering with your day, it's time to see an orthopedic physician.What options are there for severe back pain? ›
Acupuncture, massage, biofeedback therapy, laser therapy, electrical nerve stimulation and other nonsurgical spine treatments can also make a difference for chronic back pain. Talk to your spine specialist about alternative treatments that could benefit you.What can a doctor do for severe lower back pain? ›
“We usually take a conservative approach first, using a wide variety of nonsurgical spine treatments,” said Dr. Guo. “For example, I might send you to physical therapy or chiropractic therapy. I might recommend medications such as anti-inflammatories, muscle relaxants, or some nerve-pain medications.What is the difference between chiropractor and orthopedic? ›
Chiropractors diagnose and treat health problems of the musculoskeletal system and treat the effects those problems have on the nervous system. Orthopaedists focus on the prevention and correction of disorders, diseases and injuries of the joints, skeleton, muscles and other supporting structures.What to expect when going to an orthopedic doctor? ›
Your first orthopedic appointment will most likely include a comprehensive medical history evaluation, diagnostic imaging (X-rays and/or MRI), and physical tests. The following checklist will help you and your orthopedic doctor discuss the important issues for getting the most out of your first orthopedic appointment.Can an orthopedic surgeon fix sciatica? ›
What Kinds of Doctors Treat Sciatica? An orthopedic doctor can treat lower back problems. Doctors who specialize in surgery of the spine have additional training in back pain and will be able to efficiently treat sciatic nerve issues.