Lower back pain and sciatica
Low back pain is both endemic and epidemic in the population. Its incidence is such that up to 40% develop low back pain in any one year, and lifetime prevalence is up to 70%, meaning two-thirds of the population will experience back symptoms.
Lower back pain has a profound effect on both physical and psychological wellbeing, and translates into social and economic effects, affecting family life, ability to work and loss of productivity. It also impacts heavily on healthcare provision and finances.
There are many treatment modalities available, and whilst not all are curative, many can give substantial long-term alleviation of symptoms. In cases where there are recurring low back pain symptoms, repeat treatments in the form of maintenance would be beneficial.
The cause of low back pain is complex. Despite newer technologies, it is estimated that only some 30% of cases are accurately diagnosed. As a result of this diagnostic difficulty, despite up-to-date technology such as CT and MRI scans and various therapeutic diagnostic injections, treatment is often multi-faceted and conservative with medication, physical measures and injections and, when indicated, surgical intervention.
It was considered for many years that episodes of low back pain were usually shortlived. The recent literature indicates that the best single predictor of future low back pain is previous low back pain, and this has been consistently demonstrated in the bibliography. Back pain is associated with a variety of conditions, including obesity, age, atherosclerosis as well as some genetic predisposition and smoking.
Our current investigations involve clinical assessment and evaluation in the form of x-rays and CT/MRI scans. We are aware, however, that for the best results of treatment, the three cardinal factors, meaning history, examination and radiological findings, must all match, particularly if the patient is undergoing surgery. Deviation or incongruence from this presentation may not lead to the required result of treatment.
We are aware that psychosocial issues, anxiety and depression, as well as ethnic beliefs, have a profound outcome on presentation as well as outcome of treatment modalities.
Treatments available for lower back pain and sciatica
From the spinal surgery point of view, reliable results can be obtained from primary discectomy. At least 85%, if not more, of patients with a prolapsed disc and sciatica have a good recovery.
Spinal fusion has always been controversial although there are obvious criteria for a stabilisation procedure such as spondylolisthesis. A fusion for low back pain does not produce uniform results. There is some indication that one-level fusion, such as the L5/S1 level, can be of benefit, although I would stress that this is not a panacea.
Developments have included the management of osteoporotic fractures with vertebro-plasty or kypho-plasty. This is especially applicable to the older patient. This technique is can be carried out by an Orthopaedic Spinal Surgeon or a Radiologist, and the results are invariably good.
The role of interventional injections such as nerve root blocks and facet joint blocks can be of benefit, although the results are not uniform, ie they are inconsistent, but many patients do have great benefit from such procedures.
Discograms were popular as a therapeutic and diagnostic procedure, however recent literature has suggested the needle penetration of the disc can in fact cause acceleration of the degenerative disc process.
In summary, the Back Clinic seeks to establish a diagnosis of low back pain, and recommend treatment, be it advice, conservative measures or where appropriate surgical intervention.
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