Low Back Pain 

Almost everyone will experience low back pain at some point in their lives. This pain can vary from mild to severe. It can be short-lived or long-lasting. However, it happens, low back pain can make many everyday activities difficult to do.

Anatomy 

Your spine is made up of bones, called vertebrae, which are stacked on top of one another. Muscles, ligaments, nerves, and intervertebral disks are additional parts of your spine. 

The muscles and ligaments help stabilize the bones while the intervertebral disks provide "cushioning" to the spine so it can tolerate various movements and stress you place on your spine. The nerves that allow communication between your brain and your body are located inside the spine.

Understanding your spine and how it works can help you better understand low back pain. Learn more about spine anatomy: Spine Basics

Description

Back pain differs from one person to the next. The pain can have a slow onset or come on suddenly. The pain may be intermittent or constant. In most cases, back pain resolves on its own within a few weeks.

Cause

There are many causes of low back pain. It sometimes occurs after a specific movement such as lifting or bending. Just getting older also plays a role in many back conditions.

As we age, our spines age with us. Aging causes degenerative changes in the spine. These changes can start in our 30s — or even younger — and can make us prone to back pain, especially if we overdo our activities.

These aging-related changes do not keep most people from leading productive and generally pain-free lives. We have all seen the 70-year-old marathon runner who, without a doubt, has degenerative changes in her back.

Overactivity

One of the more common causes of low back pain is muscle soreness from overactivity. Muscles and ligament fibers can be overstretched or injured.

This is often brought about by that first softball or golf game of the season, or too much yard work or snow shoveling in one day. We are all familiar with this stiffness and soreness in the low back and other areas of the body that usually goes away within a few days.

Disk Injury

Some people develop low back pain that does not go away within a few days. This may mean there is an injury to an intervertebral disk.

Disk tear. Small tears to the outer part of the disk (annulus) sometimes occur with aging. Some people with disk tears have no pain at all. Others can have pain that lasts for weeks, months, or even longer. A small number of people may develop constant pain that lasts for years and is quite disabling. Why some people have pain and others do not is not well understood.

Disk herniation. Another common type of disk injury is a "slipped" or herniated disk.

A disk herniates when its jelly-like center (nucleus) pushes against its annulus. If the disk is very worn or injured, the nucleus may squeeze all the way through. When the herniated disk bulges out toward the spinal canal, it puts pressure on the sensitive spinal nerves, causing pain.

Because a herniated disk in the low back often puts pressure on the nerve root leading to the leg and foot, pain often occurs in the buttock and down the leg. This is called sciatica.

A herniated disk often occurs with lifting, pulling, bending, or twisting movements.

Disk Degeneration

With age, intervertebral disks begin to wear away and shrink. In some cases, they may collapse completely and cause the facet joints — the small joints located between each vertebra on the back of the spine — to rub against one another. Pain and stiffness result. Smoking has also been found to accelerate disk degeneration.

This wear and tear on the facet joints is referred to as osteoarthritis, also known as spondylosis. It can lead to further back problems, including spinal stenosis.

Degenerative Spondylolisthesis (Spon-dee-low-lis-THEE-sis)

• Changes from aging and general wear and tear make it hard for your joints and ligaments to keep your spine in the proper position. The vertebrae can move more than they should, and one vertebra can slide forward on top of another. If too much slippage occurs, the bones may begin to press on the spinal nerves.

Spinal Stenosis

• Occurs when the space around the spinal cord narrows and puts pressure on the cord and spinal nerves.
• When intervertebral disks collapse and osteoarthritis develops, your body may respond by growing new bone (arthritis) in your facet joints to help support the vertebrae. Over time, this bone overgrowth (called spurs) can lead to a narrowing of the spinal canal. Osteoarthritis can also cause the ligaments that connect vertebrae to thicken, which can narrow the spinal canal.

Scoliosis

• An abnormal curve of the spine that may develop in children, most often during their teenage years. It also may develop in older patients who have arthritis. This spinal deformity may cause back pain and possibly pain, weakness, or numbness in the legs if pressure on the nerves is involved.

Compression Fracture

• Vertebral compression fractures are a common cause of back pain in the elderly. As we get older, our bones become weaker and more likely to break, a condition called osteoporosis. In people with osteoporosis, minor trauma — such as sitting forcefully on a hard chair or toilet, or a gound-level fall — can cause bones in the spine to break, resulting in extreme back pain when moving.

Additional Causes

There are other causes of back pain, some of which can be serious. If you have vascular or arterial disease, a history of cancer, or pain that is always present regardless of your activity level or position, you should consult your primary care doctor.

Spine Services 

Desert Care Network Primary and Specialty Care offers advanced spine care for disorders affecting the cervical, thoracic, and lumbosacral spine. These include:

Minimally invasive spine surgery

• Microdiscectomy, microlaminotomy/foraminotomy, anterior cervical discectomy and fusion (ACDF), lateral access fusion (XLIF, DLIF)
• Cervical and lumbar decompression with or without fusion
• Spinal Fusion
• Spine oncology
• Complex spinal deformity and reconstruction (scoliosis, kyphosis) and more

Spine care at Desert Care Network begins with a focused, conservative treatment plan including core muscle strengthening to improve range of motion and body mechanics, as well as other non-operative treatment modalities. If surgery is recommended, our team of spine surgeons will customize treatment options that maximize surgical outcomes and speed recovery. Our patient education program helps coordinate pre-operative and post-operative care, including tours of inpatient facilities, brace fitting, activity restrictions, physical therapy, and home health. The overriding goal of these programs is to customize treatment options to the individual patient and facilitate the transition of care from the clinic to the hospital setting, thereby returning patients to work and recreation as soon as possible.

What is Spinal Stenosis?

Your spine, or backbone, protects your spinal cord and allows you to stand and bend. When Spinal Stenosis occurs, the spine narrows making everyday movements painful. Spinal Stenosis (or narrowing) is a common condition that occurs when the small spinal canal, which contains the nerve roots and spinal cord, becomes compressed. This narrowing can cause a “pinching” sensation of the spinal cord and/or nerve roots leading to pain, discomfort, cramping, weakness or numbness, and at its worst can affect how your bladder and bowel work.

Spinal Stenosis or Lumbar Spinal Stenosis doesn’t happen at once, but over time. Your spine, or backbone, protects your spinal cord and allows you to stand and bend.

What Causes Spinal Stenosis?

• Aging - General wear and tear and as bones begin to weaken and thin in advanced age, we become susceptible.
• Surgery - Tissue around the area may swell after spinal surgery. When this happens, it can press on the spinal cord or cause pressure on nerve endings.
• Herniated Discs - There are soft discs in between the vertebrae of the spine that act as cushioning, absorbing shock and helping to prevent back injuries.
• Trauma - Traumatic accidents in which the spine is injured can lead to extended pain.
• Paget's Disease - is a bone disease that causes patients to generate new bone more quickly than the average rate. Because the process is generated faster than normal, the bone created may be soft and weak, prone to fractures, deformed, or painful.
• Tumors - Another potential cause of spinal stenosis are tumors, even if you do not have cancer.
• Osteoarthritis - Many older adults suffer from osteoarthritis, which can also cause spinal stenosis. With osteoarthritis, bone spurs can form due to the damaged caused by wear and tear throughout your life.
• Scoliosis - a condition that causes the spine to curve rather than be straight. Its abnormal form can cause the spinal canal to narrow, putting pressure on the nerves.
• Thickening ligaments - as you age, the ligaments in the body can thicken and become less healthy and unable to properly protect the spine

What is Degenerative Disc Disease?

Degenerative disc disease refers to the symptoms of back or neck pain caused by wear and tear on a spinal disc. It is one of the most common causes of low back and neck pain, and in some cases can cause weakness, numbness, and hot, shooting pains in the arms or legs. Despite the use of the term “disease,” degenerative disc disease is not a disease, but a condition caused by natural, age-related wear and tear on a spinal disc.

What Causes Degenerative Disc Disease?

Symptoms

The most common symptom of degenerative disc disease is a low-grade, continuous pain around the degenerating disc that can occasionally flare up into more severe and potentially disabling pain. These flare ups can be the result of recent activity or abnormal stress on the spine, or can occur with no apparent cause. Other common symptoms include increased pain with activities that involve bending or twisting the spine or lifting something heavy, a “giving out” sensation, muscle tension or spasms, radiating pain in various parts of the body that feels sharp, stabbing, or hot, increased pain when holding certain positions such as sitting, standing, or looking down at something, reduced pain when changing positions frequently, and decreased pain with certain positions such as sitting in a reclining position or lying down with a pillow under the knees.

Care

If the pain from degenerative disc disease is severe and non-surgical treatments such as pain medication or physical therapy are ineffective, then surgery may be used to address it. A spinal fusion, where two adjacent vertebrae are grafted together, is the most common procedure used for degenerative disc disease, but artificial disc replacement has recently become another frequently used option.

Minimally Invasive Spine Surgery Overview

Back pain is incredibly common among Americans, affecting about 80% of us at some point in our lifetimes. This pain typically is in the lower back.

While back pain may be a passing inconvenience for most people, in some cases, this spine-related pain can be debilitating and disrupt everyday life. First-line treatment for back pain usually involves at-home care, including the application of ice or heat to the affected area and/or the use of over-the-counter or prescription pain medications or anti-inflammatory drugs.

For severe cases of spine-related pain, basic care may not be enough. Surgical treatment is the recommended option when noninvasive treatment doesn’t alleviate discomfort and other symptoms persist.

When surgery is required, minimally invasive spine surgery may be an option. For candidates who meet the criteria, this type of spine surgery offers a less invasive procedure with many recovery-related health benefits.

Benefits of Minimally Invasive Spine Surgery

In the past, open surgery was used for spine procedures. An open procedure involves “opening” the area with a large incision to give the surgeon space to move around and maneuver within the surgical area.

Recovery from an open spinal procedure is often lengthy and may have unpleasant side effects, including lingering pain. Minimally invasive spine surgery is performed through a much smaller incision, which allows the surgeon to avoid significantly damaging the muscles around the spine. Damage to those muscles is part of what requires a lengthier recovery time following an open procedure.

To provide access to the surgical area and limit damage during this minimally invasive surgery, a surgeon uses a microscopic camera to guide tiny instruments through a small incision. When compared with open spinal procedures, minimally invasive spine surgery offers patients a faster and safer procedure with reduced recovery time. Benefits also include:

• Faster recovery
• Less postoperative pain
• Less risk of muscle damage
• Less scarring
• Reduced blood loss during surgery
• Reduced need for pain medication
• Reduced risk of infection
• Smaller skin incisions

Types of Minimally Invasive Spine Surgery

While minimally invasive spine surgery isn’t an option in all cases and for all types of spine-related pain, it can be used to successfully treat a number of conditions. Conditions often treated with minimally invasive spine surgery include:

• Degenerative disc disease
• Herniated disc
• Lumbar spinal stenosis
• Scoliosis and other spinal deformities
• Spinal infections or tumors
• Spinal instability, such as spondylolisthesis
• Vertebral compression fractures

To treat the conditions identified above and others related to the spine, there are a number of different minimally invasive spine procedures. Common types of minimally invasive spine surgery include:

• Discectomy, which trims or removes the herniated portion of a disc in the back
• Kyphoplasty, which relieves vertebrae compression by inserting a balloon to restore the bones original height and injecting cement into it to rebuild the vertebrae
• Laminectomy, which removes a portion of the bone located at the back of each vertebrae to decompress the spinal nerve roots
• Lumbar fusion, which joins together two vertebrae in the lower back together to stabilize them
• Vertebroplasty, which is a procedure that injects cement into the bone to keep the bone from collapsing or breaking more

Is Surgery An Option?

Neurosurgeons employ minimally invasive surgical techniques and 3-D technology to take diagnostic images of the spine or brain for safety and accuracy.

When performing minimally invasive spinal surgery, a neurosurgeon may be able to use small incisions and tubes to remove the tumor with fewer impacts on muscle tissue. This technique may help reduce pain and speed up recovery, while allowing the neurosurgeon to decompress the nerves of the spinal cord and access hard-to-reach tumors in and around the spinal cord.

Minimally Invasive Surgery

Intraoperative neuronavigation uses an advanced MRI system to map areas of the brain responsible for important functions. The map then allows us to precisely plan surgery to help avoid damage to those important areas.

Intraoperative electrophysiology “brain mapping” (also called motor mapping and language mapping) is like GPS for the brain.

Non-surgical Intervention

Chemotherapy- Doctors may deliver chemotherapy locally to the brain during surgery. Because chemotherapy is administered as close as possible to the brain tumor edges at the resection area rather than systemically, this technique may help to reduce typical chemotherapy-related side effects.

Radiation Therapy-Doctors may also use intraoperative radiation therapy (IORT) to deliver radiation directly to the area where a tumor has been removed. This may help avoid damage to surrounding normal structures, particularly the scalp and the skin on the scalp.