LOWER BACK PAIN
Dr. Marc Darrow, M.D.

The sacrum at the base of the spine is the "keystone" bone, on which all of the most vital structures of the body rest. Besides the lower vertebrae and the rest of the spinal column that it supports, it bears the weight of the entire torso with all its major organs.
 

And since the core of the central nervous system is housed in the spinal cord, and the nerves affect not only the legs and other extremities, but also the glands and the organs, the importance of keeping this area healthy and properly aligned becomes readily apparent. It also explains why so much of the pain reported to physicians is rooted in the lower back.
 

Descriptions and diagnosis of common low back pain include:
 

Lumbrosacral strain or sprain indicates a soft tissue injury of the lower back, equivalent to a sprained ankle.
 

Discogenic syndrome is used to describe pain originating in the lumbar disk, due to tears in the annulus, release of chemical mediators, or micromotion.
 

Disc Herniation indicates a displacement of the nucleus pulposus from the intervertebral space into the spinal canal or foramen, or outside the foramen. This can "pinch" a nerve root and cause sciatica.
 

Facet syndrome describes pain originating in the zygapophyseal or "facet" joints between the vertebrae, characteristically localized in the back, aggravated by movement and alleviated by rest.
 

Spondylolisthesis is the slipping forward of one vertebral segment onto another. Retrolisthesis describes the inverse: the slipping backward of one vertebra onto another.
 

Spondylolysis indicates a defect in the structure of the pars interarticularis, while spondylosis is a catch-all phrase describing the changes that occur as a result of Degenerative Disc Disease, such as desiccation of the disk, narrowing of the interspace, inflammation, spurring or degeneration of the bone, and ligament hypertrophy.
 

Spinal stenosis is used to describe the narrowing, in part or in whole, of the spinal canal, either through spondylosis or a congenital defect.
 

Spinal instability is a very general term used when a more precise diagnosis eludes the physician. Specifically, it refers to excess motion of the vertebrae, and can be shown on flexion and extension x-rays. If instability is severe, it can cause spinal cord injury and paralysis.
 

Perhaps the most distressing is "failed back syndrome" -- an official-sounding term to describe the pain of those poor patients whose surgical attempts have failed to correct their problem.
 

The most common cause of failed back syndrome is poor judgment on the part of the physician. Surgery prescribed as a last resort, with a hope and a prayer that it might alleviate the pain.
 

Unfortunately, often times surgery does little to help, and in fact can make things worse. Frequently surgery results in post-operative scarring, which often exacerbates the initial problem or causes new pain syndromes.
 

Subsequent "corrective" surgery can help in some cases, particularly if the damage done by the first operation involves clearly observable physical complications like nerve root compression, massive scarring, bone spurring or foraminal compression.

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