Low back pain is one of the most frequently consulted orthopaedic conditions, affecting 50 – 80% of the population in their lifetime. Low back pain can be a problem faced by both young and old individuals.
Causes of low back pain include:
- Back muscle strain
- Lumbar spinal stenosis/degeneration
- Slipped disc
- Disc degeneration
- Facet joint arthritis
Do note that low back pain can also be caused by other non-orthopaedic cases such as pancreas disease.
There are also risk factors that subject some people to higher incidence of low back pain. Patients should be wary of these risk factors because many of them are modifiable. Back pain may improve if patients can address these risk factors through weight loss and lifestyle modification.
Risk factors for back pain include:
- Strain such as lifting, poor posture
The low back pain is usually mechanical in nature i.e. pain worsened by activity such as heavy load or bending forward. Patients may also complain of back stiffness. Some of the patients may experience lower limbs numbness, tingling sensation or weakness if there is nerve impingement.
Watch out for red flags symptoms such as:
- Rest pain, night pain
- Loss of weight and appetite
- Fever, chills, rigors
- Numbness, tingling sensation or weakness over the lower limbs
- Bowel or bladder symptoms
Consult an orthopaedic doctor immediately if you show the above symptoms.
X-rays and magnetic resonance imaging (MRI) of the lumbar spine (lower back) should be performed to confirm a diagnosis. X-rays of the lower back can show late features of spine degeneration. MRI would usually be indicated to better evaluate the lower back. MRI can demonstrate detailed features of the intervertebral disc, small joints of the back, muscles and nerves. If there are clinical or radiological features of nerve compression, nerve conduction test may also be performed to evaluate the function of the nerves.
The treatment for low back should be individualised according to
- patient demographics
- cause of low back pain: degenerative lumbar spine, disc, muscles or nerves
All patients with low back pain should undergo a course of physiotherapy, rest and anti-inflammatory medications. Physiotherapy includes trigger points massage, lumbar traction and muscle strengthening. Patients can also undergo lumbar spine steroid injection to reduce inflammation as well as for pain control.
There are also options for surgery if non-surgical options fail. The surgical options will depend on the cause of low back pain. Your orthopaedic surgeon will discuss in detail regarding the pros and cons for each option. There are minimally invasive options such as radiofrequency ablation, nucleoplasty for pain control. There are also minimally invasive endoscopic (keyhole) options for laminectomy, discectomy, facet joint surgery, lumbar decompression etc. You will be warded overnight and discharged the next day. After surgery, you will need physiotherapy for about 3 to 6 months. Your surgeons will review your condition regularly after surgery to make sure your recovery is on track.