Many people always have trouble with lower or upper back pain, so In this topic, we talk about Common Conditions Causes of Lower Back Pain.
90% of patients with low back pain get better within one month. A combination of time and a short period of rest with non-steroidal anti-inflammatory medications usually improves the patient’s condition.
What are the Common Conditions Causes of Lower Back Pain?
Usually, It has to do with the job or occupation.
- Job Dissatisfaction
- Excessive, Continuous Vibration at the job
- Heavy Lifting
- Stress on the back or stress and depression
- Cigarette Smoking: The typical profile is an adult male with low income that smokes cigarettes. cigarette smoke is bad for the vascularity and the nutrition of the disc.
These are some Common Conditions Causes of Lower Back Pain.
Here is a chart, that shows the intradiscal pressure and how that pressure changes with the position of the spine. So if you are supine the inter-discipline pressure is low but if you are sitting on a chair and leaning forward and lifting weight then the inter-discipline pressure is the highest in this position.
How About Waddell Signs
Waddell signs are controversial and the presence of multiple Waddell signs on examination of the patient indicates a non-organic symptom etiology. some of these signs are like overreaction exaggeration or tenderness to light touch. If you distracted a patient, The patient will give you a different response or the patient will give a pain response in non-anatomic distribution. we do not want to be judgmental or accusatory
How about the history and examination of the patient?
If the patient is worse with flexion, like in sitting then, it is a disc problem. If the pain goes to the leg then it is a disc herniation. If the back pain is more then this is discogenic back pain. if the patient is worse with extinction and there is more back pain then it is spondylosis or spondylolisthesis. but if the patient is worse with extinction and there’s more leg pain than back pain It’s probably spinal stenosis.
How about other movements of the spine like straight leg raise?
The patient will be supine and they keep the knee extended. and you flex the hip. It stretches the sciatic nerve and if the patient had pain between 35 to 70 degrees. Then there is an irritation of the nerve roots and usually, It’s 5 s1 nerve roots. That is irritated the contralateral is slight grays a positive contralateral straight leg raise is very specific for lumbar disc herniation. a positive straight leg raising could mean nerve root irritation by the herniated disc.
for surgery to be successful you need to have all these three findings together
- Positive straightly grace
- Positive disc herniation on an imaging study
- Neurological findings
If you have all these three then there’s 95% of the patient has a disc herniation. If you have the straight leg raise and the imaging then it’s about 85%. A positive straight leg raise alone could mean the patient has a 66% chance of having a herniated disc.
How about imaging usually starts with x-rays. The MRI will show abnormal discs in about one-third of asymptomatic people that are younger than four years old. There will be false-positive MRI findings in 90% of the patients that are older than 60 years old. you will find abnormal MRI findings in normal people.
Indication For An MRI
When do you get an MRI?
Pain that lasts more than four weeks and the patient is not getting better. if you suspect cauda equina syndrome infection tumor or trauma. a patient with enclosing the spondylitis or a dish even with minor trauma.
MRI with gadolinium differentiates recurrent disc herniation from fibrosis.
Fibrosis enhances with gadolinium recurrent disc herniation does not enhance with gadolinium.
Most Common Conditions Causes of Lower Back Pain
- Intervertebral disc disorders: it can be a herniated disc or it can be internal disc disruption, cauda Aquinas syndrome, or degenerative disc disease.
- Lumbar stenosis
- Degenerative sclerosis
- Failed back syndrome
- Sacroiliac joint dysfunctions
- Herniated disc: when we talk about herniated discs. we’re talking about back pain and leg pain radicular pain. l4 l5 and l5 s1 are the most common levels affected by this herniation. the usual location of the disc herniation is posterolateral. it’s a common location for the disc to herniated posterolaterally so let’s assume it’s of l5 disc herniation. that posterolateral disc herniation will affect the traversing nerve root.
So it will get the L5 nerve root but if it is a far lateral disc herniation or a foraminal disc herniation. it will affect the exiting nerve root so it will affect the l-4 nerve root in five to 10% of the cases. exiting nerve root means the upper nerve root. when you do straight leg raising it will be positive and that’s called the tension sign.
Types of disc herniation varies from
- Protrusion or Bulge
- To a herniation
- To a sequestered disc
Manifestation of L4 -L5 and s1 nerve root irritation. These are the most common findings of le4 nerve root irritation. These are the most common findings of L5 nerve root irritation. and this is the most common findings of S1 nerve root irritation.
- Code equine syndrome: Central disc herniation affects multiple nerve roots that control the bladder and the bowel. The patient will complain of back pain more than radicular pain and would also complain of bladder and bowel symptoms. Frequency incontinence and the sensation over the pre-anal area is affected early diagnosis with an MRI and early surgery is important. The internal disc disruption is called discogenic back pain. Early disc degeneration can occur due to annular tears. the patient usually has back pain and no leg pain and the pain will be worsened with flexion and sitting.
- Degenerative disc disease: There will be a loss of the disc height and the L4- L5 level is significant. Lumbar stenosis is narrowing and degeneration of the spinal canal. There are two types Central Type and Lateral Type. In the central type, the pain worsens with extinction. the patient may have neurogenic claudication and rule out vascular problems examine the pulses. Sitting and flexion of the spine will relieve the pain grocery cart sign because it increases the spinal canal size. There are cramps and heaviness of the calves the pain starts proximally and goes distally. In lateral stenosis, you’ll get ridiculous symptoms.
- Spondylolisthesis: If there’s any defect in the pars that is called spondylolysis. You see a cabbage of the vertebra due to a defect in the pars that’s called spondylolisthesis. The slippage of the vertebrae could compress the nerves and narrow the spinal canal. It can occur in younger age groups from repetitive activities such as gymnastics. There will be pain with the extension of the spine and it may progress with time.
There are multiple types but one of them is the ethnic type which is more in males L5 s1 usually involved and it will involve the l5 nerve root with hamstring spasticity.
In the degenerative type, it’s more in females. It usually affects the l4- l5level this leverage is not severe the parts remain intact and this condition is common in middle age females. In the ethnic type, there are parts defect you got stocky dark sign which the defect is seen in of like x-rays.
- Degenerative scoliosis: There are degenerative changes in the spinal disc and the facet joints causing the spine to curve it may Common Conditions Causes of Lower Back Pain.
- Failed back syndrome: Chronic back and possible leg pain that is experienced by the patient after spine surgery. It could be due to non-mechanical causes such as psychological factors, postoperative infection or adhesions, and epidural fibrosis. It may also be due to mechanical causes such as inadequate surgery, recurrent disc herniation, failure of fusion, and or fixation, and may be due to instability of the spine.
For example, if the surgeon removed one facet on one side or 50% partial facet removal but it is done on both sides. That may cause a heterogenic spondylolisthesis. These are also Common Conditions Causes of Lower Back Pain.
- Sacroiliac joint dysfunction: This is an occult Common Conditions Causes of Lower Back Pain. Pain is in the lower back region usually to the size. The favorite test is helpful in determining the presence of inside joint problems. The best method for diagnosing the presence of si joint problems is by administering an injection into the inside joint to localize the source of the pain.
And this step is extremely important if you decide to do surgery for the fusion of the sacroiliac joint. In addition to all these factors look for osteoporotic compression spine fractures in the elderly and rule out multiple myeloma or metastatic tumors. Try to rule out other conditions such as hip conditions we need to deal with spine conditions.
To be aware that help conditions and the spying conditions may affect each other not only in the management but also confuse the diagnosis. Also, try to differentiate sciatica that’s caused by a disc herniation from sciatica that’s caused by peripheral syndrome.
These are some most Common Conditions Causes of Lower Back Pain.