Lumbar Spine Pain Syndromes
Facet Joint Syndrome

CGI model of a man with back pain including spine

Signs and Symptoms:

Diagnosis:

A diagnosis of facet joint syndrome is confirmed by injecting an anesthetic and an anti-inflammatory in the joint. If there is immediate relief of pain after the injection, the condition is facet joint syndrome.

Treatment:

Radiculopathy

Man with back pain rubbing his neck with two hands

Lumbar radiculopathy is a combination of symptoms consisting of back and lower extremity pain caused by the lumbar nerve roots.

Causes of Lumbar Radiculopathy:

Signs and Symptoms:


Testing:

  • Plain X-rays
  • MRI
  • CT
  • Myelography
  • Bone Scan
  • Electromyography
  • Nerve Conduction Testing
  • Lab Work

Diagnosis:

Lumbar radiculopathy is a clinical diagnosis that is supported by a combination of clinical history, physical examination, and diagnostic studies/testing.

Treatment:

  • Drug Therapy
  • Physical Therapy
  • Spinal Nerve Root Injection
Lumbar Herniated Nucleus Pulposus (HNP)

In between each of the five lumbar vertebrae (bones) is a disc, a tough fibrous shock-absorbing pad. Endplates line the ends of each vertebra and help hold individual discs in place. Each disc contains a tire-like outer band (called the annulus fibrosus) that encases a gel-like substance (called the nucleus pulposus). Nerve roots exit the spinal canal through small passageways between the vertebrae and discs.

Pain and other symptoms can develop when the damaged disc pushes into the spinal canal or nerve roots. Disc herniation occurs when the annulus fibrous breaks open or cracks, allowing the nucleus pulposus to escape. This is called a Herniated Nucleus Pulposus (HNP) or herniated disc. A herniation may develop suddenly or gradually over weeks or months.

CGI model of a man with herniated disc rubbing neckMany factors increase the risk for disc herniation:


Signs and Symptoms:
  • Low back pain
  • Sharp pain/burning pain/stabbing pain
  • Radiating pain down the posterior or lateral aspect of the leg
  • Numbness
  • Tingling
  • Motor deficit
  • Diminished reflexes
  • Weakness
  • Prior back surgeries
  • Impotence
  • Bowel or Bladder dysfunction

Testing:

  • Physical exam
  • MRI
  • X-Ray
  • CT or CAT scan
  • Discography
  • Myelograms
  • EMG
  • Ultrasound imaging

Diagnosis:

Obtaining a vocational history is also very important because many skilled laborers or assembly line workers perform the same offending motion at work. Also a very comprehensive medical history along with proper testing can determine diagnosis as well as what type of herniation is involved.

  • Disc Degeneration: chemical changes associated with aging causes discs to weaken, but without a herniation.
  • Prolapse: the form or position of the disc changes with some slight impingement into the spinal canal. Also called a bulge or protrusion.
  • Extrusion: the gel-like nucleus pulposus breaks through the tire-like wall (annulus fibrosus) but remains within the disc.
  • Sequestration or Sequestered Disc: the nucleus pulposus breaks through the annulus fibrosus and lies outside the disc in the spinal canal (HNP).

Treatment:

Discogenic back pain

CGI model of a man with back pain

Discogenic back pain is considered a "degenerative" or aging process, patients with discogenic back pain often improve over time. Most patients with discogenic back pain will improve with time and some simple treatments.

Signs and Symptoms:

Testing:

Diagnosis:

A comprehensive medical history along with proper testing and a vocational history is important, because many skilled laborers or assembly line workers perform the same offending motion at work.

Treatment:

Iliolumbar ligament sprain

Man with back pain rubbing his neck

The iliolumbar ligament runs from the transverse process (side) of the 5th lumbar vertibrae to the back of the iliac crest. Damage to this ligament may cause pain in the sacroiliac joint area and it can be virtually impossible to tell the difference between this injury and a sacroiliac joint injury. Inflammation of the sacroiliac joints and associated ligaments are very common, especially following pregnancy where the hormone relaxing is released and results in the relaxation of ligaments in preparation for childbirth.

Signs and Symptoms:

Testing:

Diagnosis:

A comprehensive physical exam and medical history by clinician, along with appropriate testing to determine treatment is required.

Treatment:

Failed Back Surgery Syndrome

CGI model of person with crooked spine causing back pain

Failed back surgery syndrome can be due to a number of factors that doctors and researchers are still discussing. These include, Scar tissue that forms around the surgery site, interrupting normal neurological functioning.

The technicalities of the operation are not successful:


Signs and Symptoms:

  • Low back pain
  • Sharp pain
  • Burning pain
  • Stabbing pain
  • Radiating pain down the posterior or lateral aspect of the leg
  • Numbness
  • Tingling
  • Motor deficit
  • Diminished reflexes
  • Weakness
  • Prior back surgeries
  • Impotence
  • Bowel or Bladder dysfunction

Testing:

  • Physical exam
  • MRI
  • X-Ray
  • CT or CAT scan
  • Discography
  • Myelograms
  • EMG
  • Ultrasound imaging

Diagnosis:

A comprehensive physical exam and medical history to establish an understanding of an individual's pain and characteristics of the pain such as: onset/offset, character/radiation of pain, associated symptoms, time pattern, exacerbating/ameliorating factors and severity.


Treatment:

Vertebral Compression Fracture

CGI model of a man with back pain rubbing lower back

What causes vertebral compression fractures?

The leading cause of vertebral body fractures is osteoporosis. The following factors will increase the likelihood of acquiring osteoporosis:

Signs and Symptoms:

Diagnosis:

A targeted history and physical examination combined with appropriate testing should help the clinician to identify and properly treat this condition.

Treatment:

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