Spinal disorders: lumbar

Lumbago or back pain is one of the most frequent causes for medical consultation and the main reason for absence from work. When we evolved from walking on four limbs to using only two this standing posture places all the weight on the lower part of the back and a great deal of tension is accumulated in this area. Furthermore our lifestyle habits, postures, jobs, lack of exercise, etc. all cause faster degeneration of the lumbar area.

In the majority of cases, rest, drugs and exercise resolve the discomfort. Nevertheless, should the pain persist, it is important to visit a neurosurgeon expert in the spine for a precise diagnosis of the cause of the pain.

The main pathologies of the lumbar region are:

• Slipped disc: this occurs when a fragment of discal tissue moves and compresses nerve structures. It is important to assess the size, location and relationship to the structures surrounding the slipped disc.
• Discopathy: genetic or environmental factors may cause wear of the disc resulting in discopathy (disc disease). This causes overload of the lower spine, resulting in back pain.
• Spondylolisthesis: this occurs when one vertebra moves in relation to the one immediately below it. Normally it is associated with instability and compression of nerve structures.
• Scoliosis: this term is used when the spine has a sideways curve (coronal plane). There are two types:
  • 1- Congenital which starts in infancy and progresses with growth
  • 2- Degenerative: caused by vertebrae wear.
• Spinal stenosis: this occurs when the canal the nerves pass through becomes narrower. It typically causes neurogenic claudication with the appearance of pain or lack of strength in the legs when walking and which abates when seated.
• Vertebral fractures: there are three main causes of fractures:
  • 1- Traumatic
  • 2- Osteoporotic
  • 3- Pathological (there is a possible underlying tumoural lesion).

  A correct workup is essential to assess the cause and offer a suitable treatment.