Sahyadri Hospital

Low Back Pain

A low back pain has now become the problem of the century. It is one of the most common symptoms experienced by virtually everyone at some point of time in his/her age. Age for back pains varies from approximate 20 years to 65 years. There are number of factors linked with low backache but only few are known to society at large. One of the common causes known are obesity, inactive or sedentary life style, lack of exercises. Above mentioned causes are cumulatively known as “modernization”.

Since it is one of the most common symptom experienced by almost everyone, many times gravity of the situation underlying, is not considered seriously. This leads to progression of the disease, which needs more invasive treatment in future, in case not paid attention to, on time. The spectrum of the diseases causing back pains is vast. It ranges from simple ‘age related degeneration’ to more aggressive ‘tumors of spinal column’. Dose this mean that every time I get low back pain, there has to be a tumor? The answer is “NO”. Here comes the role of clinician who can make out the differences between a benign and malignant pathology. At young age less harmful disease like osteoporosis, slip disc and fractures are common and disease like spinal tumors are common at older age. There is a term called “spondylosis” which in English means “age related degeneration of spine”, has been, unfortunately presented as a disease entity, which is not a disease in reality.

There are numbers of measures, which can slow down the degenerative processes to significant extent. Few of them are daily exercises on regular basis. Walking, swimming, cycling, rope skipping are supposed to be the best exercises for paraspinal muscles that help us to stand against gravity. Smoking or use of tobacco in any form impairs the repair mechanism of spine leading to progressive degeneration. So quitting tobacco is the best possible gift for spine. Posture correction while sitting for a long time and while working with computer, especially in “IT people” helps a lot to get over the low back pains.

Back pains not responding to conservative means mentioned above need radiological evaluation. MRI(magnetic resonance imaging) is considered gold standard investigation modality in spine pathologies. But at the same time, MRI pictures are not representative of the disease i.e. a perfectly normal individual can be diagnosed to have large slip disc without any symptoms and at the same time a severely symptomatic individual may have a relatively small slip disc seen on MRI. Hence clinical correlation is extremely important while considering treatment options. Traction therapy has no role or role similar to simple bed rest, in treatment of slip disc disease.

The million-dollar question arises after correlation of MRI and the clinical picture and that is – “DO I NEED SURGERY FOR SLIP DISC?” The answer is “NO-NOT EVERY TIME”. About 60% patients, who have positive correlation with clinical signs and MRI, are “CURED” with conservative means alone, without any need for surgery. About 80% of the remaining patients, still do not need surgery if they are subjected to carefully chosen procedures that are known as LEAST INVASIVE SPINE PROCEDURES. Ozone nucleolysis is one of the best-known treatments in this category. This group of treatment does not need open surgery and are performed under local anesthesia, on day care basis. Only a few selected patients NEED surgery. There are two categories of surgery viz. open and endoscopic. Depending upon the pathology, appropriate method is chosen. With refinement in techniques and technology, the number of life threatening complications in routine spine surgery has almost become zero.