Dr. Matthew McDonnell recently participated in the WCTC Health and Wealth Forum at The Pines Manor in Edison, NJ. Presenting on low back pain and the common problems of the lumbar spine, Dr. McDonnell highlighted the fact that 80-90% of adults experience some form of back pain at least one time in their lives. Back pain is second only to upper respiratory colds as the most common problem for which patients seek medical attention. The ailment costs Americans billions of dollars each year in medical and non-medical expenses, like loss of productivity and disability.

When a patient comes in for a consultation, Dr. McDonnell performs an extensive history and physical examination in order to determine the source of the back pain. Often times, imaging studies such as x-ray and MRI are necessary to make a diagnosis. Some of the most common conditions he treats follow.

Lumbar Disc Herniation

Lumbar Disc Herniation is most common in patients in their thirties and forties. This condition often occurs as a result of degenerating discs in the spine. Discs are located between the vertebrae and serve as cushions between the bones. When the disc begins to degenerate, the inner core can bulge or herniate into the spinal canal or nerve tunnels. A herniated disc can put pressure on a spinal nerve and produce significant pain. The patient can present with back pain or with pain radiating into the buttock or leg. This referred pain is termed radiculopathy, or “sciatica.” At times, the referred pain can be extremely uncomfortable or even debilitating.

Patients with a lumbar disc herniation can also develop weakness and numbness or tingling in the legs.

Lumbar Disc Herniation Treatment

Treatment for herniated discs varies based on location and severity. Many people have bulging or herniated discs without noticing or experiencing pain. Many patients with pain from a herniated disc will improve without surgery. Doctors recommend relative rest and the use of anti-inflammatory medication, muscle relaxants, or oral steroids to help provide relief for patients experiencing severe pain. Physical therapy is often prescribed to strengthen the muscles that support the spine making it less prone to injury. Injections of steroid medication into the spine around the nerves are another non-surgical option. Physicians inject steroid medication into the epidural space or around the irritated nerve root.

Surgery is reserved for patients who fail to improve the nonsurgical methods discussed above and in patients who are experiencing persistent disabling pain or progressive and significant weakness. The surgery to treat a disc herniation is usually a microdiscectomy. This removes the herniated disc and eliminates the pressure on the surrounding nerves.

Degenerative Disc Disease

In some patients, as the spine ages, an intervertebral disc can degenerate. A degenerated disc can result in deep-seated low back pain that usually becomes worse with prolonged sitting or standing. In addition, bending or axial loading will make the pain worse. In contrast to herniated disc pain, pain from degenerative disc disease tends to cause isolated low back pain without referred pain to the legs.

Treatment of Degenerated Discs

Degenerated discs are usually treated non-surgically. Non-steroidal anti-inflammatory medications like ibuprofen can be helpful for managing the pain. Physical therapy can also be helpful for patients as part of the pain management and to stabilize the core muscles that support the spine. Physicians may advise patients to modify activity such as avoiding prolonged periods of sitting. Low impact aerobic activity can both improve symptoms and help patients who would benefit from weight loss. Surgery is only advisable in cases of severe symptoms lasting for more than six months and when all other methods of treatment have been ineffective.

Lumbar Spinal Stenosis

Lumbar Spinal Stenosis commonly occurs secondarily to degenerative or arthritic changes to the lumbar spine. This change causes a reduction in the dimensions of the spinal canal (the space for nerve roots) and the nerve tunnels (foramen). These changes can cause pain in the lower back, as well as referred pain radiating to the buttocks and legs. The pain is known as neurogenic claudication and is often worse with walking. The referred pain tends to be relieved by rest. Patients may also experience weakness or numbness and tingling in the legs.

Lumbar Spinal Stenosis Treatment

Non-surgical approaches are always exhausted first. Similar to other lumbar spine conditions, conservative treatment of lumbar stenosis includes the use of anti-inflammatory medication, physical therapy, and epidural steroid injections. When these approaches are not effective, surgery is considered. For spinal stenosis patients who have persistent pain or neurologic deficits like weakness, and bowel or bladder dysfunction, surgery can be a helpful solution. Surgeons perform a lumbar decompression or laminectomy to relieve pressure on the surrounding nerves.

Degenerative Spondylolisthesis

This condition occurs when there is forward slippage of the vertebral body as a result of instability that develops secondary to advanced arthritis. As the intervertebral discs and facet joints degenerate, the spine loses the ability to hold itself in place. As one vertebrae slips forward on another, the dimensions of the spinal canal or nerve tunnels may narrow, resulting in stenosis or pressure on the nerves. Patients with this condition can present with both back and leg pain. This condition is common in older patients. Females are more susceptible to the condition than men.

Degenerative Spondylolisthesis Treatment

The condition is treated with similar non-surgical approaches as the other common lower back conditions. These include anti-inflammatory medication, physical therapy, activity modification, and epidural steroid injections. Surgery involves a laminectomy or decompression to relieve the pressure on the nerves, and performing a spinal fusion which improves stability in the area and prevents further slippage. Spinal fusions are usually performed with screws and rods inserted into the vertebrae.

At UOA, our spine team is prepared to manage all of your spine conditions. Using our years of experience and specialized areas of interest, we exhaust all non-surgical approaches before considering surgery. If surgery is indicated, we choose the most minimally invasive approaches when possible to get you back to your optimal health and lowest pain levels as quickly as possible. For more information, schedule an appointment with one of our spine experts by calling 732-537-0909.