Back (lumbar) pain

Page Content

Symptoms

Tab 1 Content

Back pain is the most common cause of musculoskeletal cause of disability worldwide. Up to 40% of all adults may experience back pain every year. While most cases of acute back and neck pain resolve naturally, it is important to see a specialist if these symptoms do not resolve after 6 weeks or more. This is especially so in patients with symptoms such as:

Sciatica/pain travelling to their limbs (radiculopathy),
Associated numbness, weakness or paraesthesia (tingling sensation in the limbs),
Symptoms suggestive of spinal cord compression such as loss of stability when walking and clumsiness or loss of function in the hands.

Patients who have back pain associated with trauma, fever, which keeps them from resting or sleeping, loss of weight or loss of appetite and loss of bowel or bladder control (incontinence) should seek immediate medical attention.

Diagnosis

Tab 2 Content

A consultation with a spinal surgeon will include a through consultation and physical examination followed by investigations such as:

Conventional X-rays
EOS Imaging: a low radiation form of weight bearing x-ray used to study the overall alignment of the whole body and spine
CT Scan: A non-invasive procedure that uses X-rays to produce a three-dimensional image of the spine, which is used to study the bony anatomy of the vertebrae for surgical planning and diagnosis
MRI: Magnetic resonance imaging (MRI) uses magnetic fields and radio-frequency waves to create an image of the spine and allows the surgeon to study the vertebrae, disc, spinal cord and nerves in detail.

Management

Tab 3 Content

Non-surgical management of back pain can include

Medications
Physiotherapy
Acupuncture
Braces/Orthoses

Most patients with spinal conditions can be treated non-surgically. Physical therapy, lifestyle modification, medication, acupuncture and spinal injections may be recommended prior to surgery. Surgery will be recommended only after these measures have failed, if there is further progression of symptoms or if the patient’s condition is not suited for non-surgical treatment.

The goals of surgical treatment are to relieve symptoms, correct spinal deformities and to stabilise the spine. The use of minimally invasive techniques and endoscopic surgery has led to a reduction in post-operative pain, duration of hospital stay and earlier return to daily activities. Motion preserving procedures such as disc replacements or in the cervical and lumbar spine are also performed in our institution, to allow continued motion in our patients. State of the art technology such as operative microscopes, intraoperative neuromonitoring and intraoperative imaging/navigation systems such as the O-arm has also led to an improvement in patient safety.