Living with Lower Back Pain. Part II: Diagnosis, Non-Surgical & Surgical Treatment
This is the 2nd in a series of 3 articles related to lower back pain.
People with LBP represent a wide variety of presentations and outcomes. Studies show 85% are fully recovered in 3 months regardless of the intervention. Some of my LBP patients are fully recovered and live normal, active lives, such as Paul Ezbianski, who has run 10 Steamtown Marathons. Others have on occasional and short-term flare-ups of LBP, such as Dr. David Hazzouri, and comfortably golf, ski, weight-train and practice cosmetic dentistry. Unfortunately, others suffer through a life of chronic back pain that occurs more frequently and intensely each year, such as my mother, Angeline Mackarey.
Thorough examination and accurate diagnosis is essential in expediting your complete recovery.
(Rothman)
* Your physician will determine which test is most appropriate for your problem.
A comprehensive team approach includes your primary care physician, orthopedist, neurologist, neurosurgeon and physical therapist. A thorough history and physical exam are important components. The exam includes: muscle strength tests. postural assessment, functional testing, neurological examination of muscle function, reflexes and sensation. Further diagnositic testing may be necessary.
Assess the bones of your spine for abnormal anatomy and can rule out a fracture, slippage of the vertebrae. An x-ray with bending into flexion and extension can detect abnormal spinal motion.
An advance test to diagnose spinal problems involving the bones, discs, nerves and other soft tissues of the spine in more detail than an x-ray.
A special x-ray test used to examine the spinal cord, spinal canal, spinal cord, spinal nerves and discs. A radiologist injects dye into the spinal canal to enhance the view spinal structures. This test can determine if nerve compression from a disc or spinal stenosis and rule out spinal tumor or abscess. Also, a CAT scan can be performed with the myelogram.
A special test with a more detailed view than an x-ray. It is useful to identify boney spinal abnormalities, spinal nerves and fractures.
An electrical test used to identify problems with the nerves from the spine to the extremities. A needle is placed in the muscle to detect abnormal electrical responses from nerve damage from a disc, stenosis, or disease such as diabetes.
A special test using a dye injected into the disc to examine the structure and health of the disc and its relationship to the associated nerve. It is often used before fusion surgery.
(Rothman)
* Your physician will determine which non-surgical treatment is most appropriate for your problem.
Medication for LBP focuses primarily on pain and inflammation. In most cases, over-the-counter anti-inflammatory medications such as ibuprofen (Advil or Motrin) or aspirin (Bufferin) are very effective. These medications can reduce swelling and pain but should not be taken for longer than a few days without consulting your doctor.
Physical therapy (PT) by an orthopaedic physical therapist is recommended for the conservative management of LBP in most cases. Heat or cold, ultrasound, massage, electrical stimulation are often used to decrease pain and promote healing. Manual therapy (manipulation) and traction can be used to decompress the spine and reduce symptoms. Once pain is managed, mild range of motion, strengthening and stabilization exercises are employed. Instruction in proper body mechanics, ergonomics, exercises and a home program is an essential component to the PT program.
If the above conservative measures have failed to provide success in pain reduction and return to activity, often the next step is to consider injection therapy. Three primary injections are: steroid injections (decreases inflammation to the spinal nerve to reduce swelling and pain directly on the nerve), spinal nerve block injections, (interrupts the pain signal from the spinal nerve) and facet joint injections (reduce pain from degeneration and inflammation of the joints in your spine.
Many nontraditional therapies are not scientifically proven but may be worth a trial if the potential benefit outweighs the risk. Some of these include: acupuncture, acupressure, antidepression medication, and glucosamine chondrotin supplements.
(Rothman)
* Your physician will determine if surgical treatment is appropriate for your problem.
Please remember that most people suffering from LBP do NOT require surgery!
80-85% of people with LBP are better in 3 months.
You may be a surgical candidate if :
Discectomy
A surgical procedure performed on patients with a herniated disc in which the herniated part of the disc is removed to relieve pressure, swelling and pain. Once the nerve is relieved of pressure, healing can begin and function restored.
Laminectomy
A surgical procedure performed on patients with spinal stenosis. The lamina, bone that makes up the roof of the spinal canal protecting the spinal cord, is removed. This enlarges the opening for the spinal cord to pass free of impingement. A discectomy can be performed in combination with the laminectomy if necessary.
Spinal Fusion
A surgical procedure performed on patients with instability or abnormal motion in their spine. Two or more vertebrae a fused together using bone graft and/or instrumentation or hardware such as screws plates rods, hooks and wires. A discectomy and/or laminectomy may be performed with the spinal fusion.
Visit your doctor regularly and listen to your body.
NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!” “Prevention of Lower Back Pain”
This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com
Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an affiliated faculty member at the University of Scranton, PT Dept.
