How to treate back pain?

The causes of lower back and/or leg pain can be numerous. Since different ailments can be manifested by the same signs, a detailed clinical examination and precise diagnosis by X-ray and/or magnetic resonance imaging are required. The pain caused by the pressure of the disc on the nerves in the lower back is most often manifested as pain in the legs (sciatica).

Except in extremely rare situations that are solved surgically, most complaints will pass with conservative therapy, painkillers, physical therapy (ultrasound, laser, decompression, exercises). In case of failure of conservative treatment, the so-called  minimally invasive diagnostic and therapeutic procedures can be recommended. After a possible cause of the pain is found on the magnetic resonance imaging (there may be several), under local anesthesia, long thin needles, under the control of the X-ray machine with contrast, a short-term local anesthetic is applied to the most likely place that causes pain. If the pain goes away after administration, we have confirmed the location of the cause of the pain. Through the same needle, a long-acting anti-inflammatory drug, anesthetic or other drug, i.e. preparation, can be given. The patient can go home immediately. The advantage of such drug administration is the precision of the place where the drug acts. By administering such drugs in the usual ways, through the mouth, into a vein or into a muscle, the drug circulates throughout the body and reaches the painful site in a lower concentration. At the same time, do not forget of the side effects of such drugs. If even with such procedures we have not alleviated the complaints, surgical treatment is performed. In the case of the so-called disc herniation, the inner part of the disc ( cartilage between two vertebrae) moves out of its socket and presses on the spinal cord and/or nerves), it is necessary to remove the disc. Instead, a metal implant (so-called cage) is placed, the function of which is to keep the distance between the vertebrae. It is also possible to place a disc endoprosthesis, which, in addition to its supporting function, retains the ability to move between the vertebrae, just like a healthy disc. In case of damage to multiple discs and associated small joints, and the resulting instability, it is necessary to fuse the spine with metal implants. This sacrifices part of the mobility though eliminates the pain.

Almost all people will have lower back pain at least once in their life and seek the help of a doctor. Fortunately, most of these pains go away without treatment or after physical therapy with painkillers. The usual algorithm when pain occurs is as follows. In case the patient does not have the so-called red flags ( i.e. warning signs) e.g. sudden muscle weakness in the legs, inability to control stool and urine, previously treated malignancy, disease, acute injury, high temperature, etc. treatment begins with short-term rest (a few days) and anti-inflammatory drugs pain, and possibly Physical therapy. In the event that there is no worsening of the symptoms, most will pass within 6 weeks. If after this time the patient still has problems, it is necessary to perform  magnetic reozonation images (MRI). The possible cause of the complaints will be identified by analyzing the images, and the urgency and type of treatment will be assessed based on the patient's subjective complaints. After that, it is necessary to accurately determine the location of the pain (there may be more then one) using minimally invasive (MI) diagnostic procedures, and then treated with MI therapeutic procedures. In case of failure of such treatment, if, for example, the cause of the pain is a herniated disc, under local anesthesia, using an endoscope and special instruments, it is possible to remove the disc. The patient goes home the same day. Sometimes it is a larger area that is the cause of the pain, so classic surgery solves the problem. Today, there is the possibility of several different minimally invasive surgical approaches as well as classic open surgeries. 

Sometimes the patient feels pain in the legs after a certain number of steps. He notes that his walkway is shortened. In middle and older age, ussual reason is spinal stenosis. The nerves in the lower back are pressed by the remains of the damaged disc and growths of the surrounding bones, osteophytes (bone spurs) and thickened, i.e. enlarged, as well as arthrotically changed small joints of the spine. Over time, the spinal canal narrows. During the operation, all elements that press on the nerves must be removed. Sometimes  during such a procedure larger parts of the joints are removed and they become unstable. Such vertebrae need to be stabilized using screws and special rails connecting the screws.