Stop Suffering From Lower Back Pain: Here’s How To Find Relief Now

Aetiological factors

1. Trauma
2. Inflammatory, e.g., rheumatoid arthritis, ankylosing spondylitis, etc.
3. Degenerative: Spondylosis (degenerative disease), prolapsed intervertebral disc, spondylolisthesis
4. Neoplastic: Usually secondary tumors
5. Infection: Pyogenic, non-pyogenic (Tuberculosis-Prott’s disease)
6. Spinal stenosis: Congenital degenerative
7. Others: Kyphoscoliosis

Clinical Features

1. History at presentation includes the following:

• Pain: Sharp and localized, chronic and diffuse
• Referred pain (sciatica): Pain radiates into the lower limb, may be aggravated by coughing, straining, etc.
• Stiffness
• Deformity, e.g., TB spine

1. Numbness or parasthesia in the lower limb
2. Urinary retention or incontinence (can be due to pressure or cauda equina)
3. There may be a history of trauma, heavy lifting, neoplasm, connective tissue disorder like rheumatoid arthritis.
4. Physical findings at presentation are demonstrable by:

• Inspection

-Skin-may show scars, pigmentation, abnormal hair.

-Shape and posture may be abnormal and suggestive.

• Palpation

-Feeling for tenderness is likely to elicit it.

-Motion-May be impaired.

-Sensation-May be diminished  if nerves are involved.

-Reflexes-May be diminished if nerves are involved.

-Straight leg raising test. Discloses lumbosacral root tension.

1. Examining the other systems.

Investigations

1. Plain radiographs: Anteroposterior, lateral, and oblique views of spine may shoe:

• Osteophytes and disc degeneration in spondylosis
• Loss of lumbar lordosis, which signifies muscle spasm due to pain
• Anterior shifts of an upper segment upon lower, which indicates spondylolisthesis.
• Bone destruction with sparing of intervertebral discs is noted in tumours
• Sclerotic metastasis are seen in Ca prostate
• Bone destruction in infective conditions, e.g., TB. There may be a gibbus (sharp angulation) deformity.
• Radioisotope scanning: May pick up areas of increased activity suggesting a fracture, silent metastasis, or local inflammatory lesion.
• Computed tomography: May pick up structural bone changes, e.g., fracture, tumor, and intervertebral discs prolapse.
• Magnetic resonance imaging (MRI): Discs, nerves, and other soft tissues are clearly seen.
• Other investigations include:

-Those based on the likely working diagnosis, e.g., abdominal ultrasound in suspected tumours.

-Erythrocyte sedimentation rates in suspected tumor, TB, connective tissue disease.

Management

Most cases of disc prolapse will improve on conservative management.

1. Give analgesics to control pain ibuprofen 400mg TDS. In suspected tuberculosis without neurological deficit, a trial of anti tuberculosis therapy can be given. If there is no improvement in 3 to 4 weeks, refer to the specialist.
2. Initiate physiotherapy for spondylosis and spondylolisthesis, and where nothing specific is picked up on imaging.
3. Stable fractures will heal conservatively on bed rest (orthopedic bed). A hard lumbosacral corset may be fitted after 6-8 weeks and used for further 4-6 weeks or until the pain is bearable. For unstable fractures, refer to a suitable facility for further management.
4. In suspected tumours, neurological deficit, pain that is not improving, etc., refer the patient to a level 5 facility and above.