Lower back

Back Conditions

Minimally Invasive Techniques Used — Nitin Khanna, MD

Black-and-white photograph of a person seen from behind, pressing a hand into their lower back

01 — Overview

Overview

Back (Lumbar) pain can be very difficult to treat. Successful treatment depends on early and accurate diagnosis. The first step for many patients is over-the-counter medications and some basic stretching exercises. If those fail, a doctor may order an MRI to obtain a look at the condition of the discs and spinal facet joints.

Unfortunately, many patients still suffer from back pain with an essentially normal MRI. Clinicians and patients alike can be very frustrated by this diagnostic dilemma. Recommendations for pain medications and non-specific injections will lead to unsatisfying results and continued pain.

And, lumbar pain is a common ailment that affects a growing number of Americans on a yearly basis. Many symptoms will improve over time and not require any type of medical intervention. The question is: When is back pain severe enough to need to be evaluated by a medical professional?

A person seated at a desk, seen from behind, leaning in over a laptop with their shoulders rounded forward

Patients with a long history of back pain may be suffering from degenerative conditions of the spine such as arthritis and degenerative disc disease. But, when other treatment methods have been utilized without effect, it may be time to investigate other symptoms and treatment methods. This is true especially if symptoms are severe and are associated with radiation of pain in the arms or legs and/or if weakness is present in the arms or leg, it is time for a full evaluation. Often this is a sign of injury to a disc which may be compressing a nerve. In these situations, an expeditious evaluation can significantly improve results.

Our understandings about surgical treatments and pain injections have also progressed over the years. Injections can be very helpful for the treatment of acute injuries, such as a disc herniation, but their long-term effectiveness and use in treating chronic conditions have been called into question. There is an increasing body of evidence supporting minimally invasive spine surgery leading to decreased recovery times for patients. These advanced techniques are based on decreasing the muscle dissection and blood loss associated with open procedures. Surgical procedures on the back can now be done on an outpatient basis with little down time for the patient.

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02 — Conditions & procedures

Back Conditions & Procedures

Two clinicians in white coats holding stethoscopes out towards the camera

Common Lower Back (Lumbar) Conditions:

These conditions produce overlapping symptoms, and only an examination and imaging can tell them apart.

Nerve pressure

3 conditions

Radiculopathy

The term for irritation or pressure involving a nerve root, the point where a nerve leaves the lower spine on its way toward the leg.

What it feels like Discomfort, tingling, or numbness may follow a narrow path from the lower back into the leg or foot.
Pinched Nerves

An everyday phrase for a nerve in the lower spine that can be crowded by nearby bone, disc, or soft tissue.

What it feels like A dull ache with tingling or numbness may be noticed in a limited area of the lower back, hip, or leg.
Spinal Arthritis & Spinal Stenosis

Arthritis refers to changes at the small joints of the lower spine, and stenosis to narrowing of the spaces where nerves pass.

What it feels like Aching low in the back may come with heaviness or tiredness in the legs, which can be noticed while standing or walking.

Discs and cushioning

2 conditions

Herniated (Bulging) Disc

Discs are cushions between the bones of the lower spine, and this term describes a cushion that extends past its normal edge.

What it feels like Aching may be felt low in the back, with tingling or a warm, prickling sensation that can travel into the buttock, thigh, or calf.
Degenerative Disc Disease

This name refers to the soft cushions between the bones of the lower spine being thin, dry, and stiff rather than springy.

What it feels like A dull ache may be described low in the middle of the back, and can be noticed while sitting, bending, or lifting.

Bone and structure

3 conditions

Spinal Bone Spurs

These are small, smooth ridges of extra bone found along the edges of the bones and small joints of the lower spine.

What it feels like Stiffness and a dull ache may be noticed in the lower back, with tingling where a nerve sits close by.
Spondylolisthesis (Slipped Disc)

Despite the popular name, this term describes a bone of the lower spine sitting forward of the bone directly beneath it, not a disc.

What it feels like A deep, tight feeling may be described across the lowest part of the back and through the back of the thighs.
Spinal Trauma/Fractures

These terms cover a crack or break in a bone of the lower spine, and can involve the tissue around it.

What it feels like Tenderness may be felt over a particular spot on the back, and sensation there can change with movement or position.

Joints and prior surgery

2 conditions

Sacroiliac Joint Dysfunction

A term for altered movement or alignment at the sacroiliac joints, where the base of the spine meets the pelvis.

What it feels like Soreness may sit low and off to the side, near the dimple above the buttock, and can be felt toward the groin.
Failed Back Surgery Syndrome

A label for discomfort still described in the lower back or leg by a person who has had spine surgery before.

What it feels like Aching may be described across the lower back, with tightness or discomfort that can extend into the buttock or a leg.