What is Low Back Pain?

Low back pain is often caused by conditions of the spine or injuries to the muscles and ligaments in your back. Some of the more common causes include degenerative discs or vertebrae as a result of aging. Arthritis and everyday wear and tear on your joints can also account for back pain. In either case, your back may become less stable resulting in lower back pain.

If you are experiencing low back pain, book an appointment online with Prof. Pier Paolo Maria Menchetti at UPMC Salvator Mundi International Hospital for treatment options.

What are the Types of Lower Back Pain?

• Discogenic – Discogenic back pain is often experienced by people between 30 and 50 years of age. It can be acute, chronic, or recurrent. It is defined as acute when it lasts less than six weeks. It is defined as chronic if it lasts longer. Recurrent low back pain occurs when there are long periods of well-being between episodes of pain.
• Acute discogenic back pain usually occurs when the fibers that protect the discs in your back break or separate. This can result in pain when moving and/or a bulging disc. Symptoms include frequent, intense pain that causes difficulty walking or standing up straight. If you still experience pain after three weeks, your doctor may order an MRI to assess for degenerative disc disease or disc narrowing.
• Arthrogenic – Arthrogenic back pain is usually experienced by people over 50 years of age. It is often chronic and can be diagnosed using X-ray, MRI, and CT scan to detect arthritis in the facet (the connections between the bones in your back) joints, lower spine, and to assess degenerative disc disease or disc narrowing. Some patients with arthrogenic back pain may also be diagnosed with facet joint syndrome, which can lead to increased arthritic pain or inflammation.
• Other Causes – If your specialist has ruled out back pain related to the above conditions, they may conduct additional testing to rule out other diagnoses. In most cases, however, where there are no indications of spine or disc damage, lower back pain can have no known cause.

How Do You Treat Low Back Pain?

Treatments for lower back pain include non-invasive and invasive options.

What Are Some Non-Invasive Options?

• Bedrest, anti-inflammatory, and muscle relaxing medicine
• Physical therapy
• Anti-depressants

When Is Surgery Required?

If your pain is not reduced with non-invasive therapies, your spine specialist may recommend surgery. Surgery can be percutaneous, semi-percutaneous, or open.

Percutaneous or Minimally Invasive Surgery

This type of surgery is also referred to as minimally invasive surgery.

For patients with arthogenic low back pain, spine surgeons use imaging to guide electrodes to the area of pain. The electrodes emit a safe level of heat that destroys the damaged nerve and alleviates the pain. In some cases, patients may be asked to undergo an anesthetic test prior to the procedure. Here, a local anesthetic is injected into the area where the electrodes will be placed. If the patient has marked improvement during this test, there is evidence that the percutaneous procedure will be effective. Approximately 85% of patients see improvement following this procedure.

Intradiscal Electrothermal Therapy (IDET) is a percutaneous option that may be considered for discogenic low back pain. Using X-ray guidance, a thin catheter is placed in the disc. The catheter has a generator that creates a safe level of heat which destroys the damaged nerve fibers on the disc. This procedure is not widely used.

The last percutaneous option is a procedure that replaces damaged disc tissue with healthy disc tissue. It is currently in early stages of review and is still considered experimental.

Semi-Percutaneous Surgery

Semi-percutaneous procedures are performed under local anesthesia and involve a small incision in which a spacer is placed between the vertebrae to increase the space between vertebrae. This is done under X-ray guidance and is effective in patients with discogenic low back pain and arthogenic low back pain. It also may be effective in patients with facet joint syndrome if the patient experiences relief following the anesthetic test described above. Results are favorable in approximately 70% of patients.

Open Surgery

Using a traditional open incision, spacers are placed between the vertebrae to increase the space between vertebrae. This provides greater stability to the two vertebrae and, to some extent, limits the flexing movement of the vertebrae. Approximately 85% of patients see improvement following this procedure.

While still in the early stages, surgeons are evaluating an open surgical procedure in which damaged disc tissue is replaced with healthy disc tissue. Results are not yet clear on this option.

For young or middle-aged patients, spine surgeons may consider replacing damaged discs with synthetic new discs. This is often effective for patients diagnosed with discogenic low back pain. This is considered a new approach and results are not yet consistent.

Perhaps the most traditional open procedure is the fusion of the two vertebrae that are adjacent to the damaged disc. Surgeons find this procedure ideal for patients with discogenic back pain or back pain from arthritis.

Spine Center at UPMC Salvator Mundi International Hospital

The Spine Center at UPMC Salvator Mundi International Hospital is an innovative and multispecialty center for the diagnosis and treatment of spine disorders and diseases. For a diagnosis and treatment options, book an appointment online today with Prof. Pier Paolo Maria Menchetti.