LOW BACK OR THORACIC PAIN

Disc degeneration
Disc hernia
Spinal stenosis
Fractures

Available treatments

  1. Lumbar Discoplasty
  2. Endoscopic Discectomy
  3. Lumbar microdiscectomy
  4. Disc replacement
  5. Minimally invasive fusion

 

Back pain is pain in the lumbar region, mainly in the lower part. This is a common problem, since studies have shown that by the age of 20 about 50% of the population would have experienced low back pain. The percent reaches at 80% by the age of 60 years and is second in frequency after the common cold. A percent of 2%  is diagnosed with simultaneous symptomatology of the sciatic nerve, causing pain reflecting to the leg (sciatica).
Causes of LBP are mostly degenerative diseases of the intervertebral disc, referred to by specialists as "degenerative spine disease". More specific diagnoses are compression fractures of the spine (eg. in the case of osteoporosis), spondylolisthesis, - in cases of younger and older age groups, the tumors, ankylosing spondylitis and inflammation. Nevertheless, the intervertebral disc herniation is the most common cause of lumbago-sciatica. The symptomatology is generated, when under various chronic conditions, the external hard disk casing( annulus fibrosus) "breaks"  , resulting in the inner soft content (nucleus pulposus) to "slip" back, compressing the spinal cord or nerve roots, leading to the symptoms, formerly analyzed.
The initial treatment of low back pain includes some general principles, such as education on the correct kinetic model and feedback, so that the patient can learn the right attitude of his body , in order not to overload his back. Additionally, focus on specific exercises that relate to the back, such as the strengthening of the trunk (abdominal-dorsal), as well as muscle stretching exercises of the back and hamstringσ. The  initial therapeutic approach includes medication , such as  Non Steroidal Anti-Inflammatory Drugs (NSAIDs), as well as the application of cold and wet patches.
But if the pain still persists and / or worsens, as well as if you have weakness or numbness (ie, transient loss of ability to move one or both legs, or numbness in the legs), and disorders of urination and defecation (cauda equina syndrome), surgical treatment is highly recommended, with first option the Transforaminal Endoscopic discectomy, under local anesthesia and sedation. This ensures a complete removal of the hernia with minimal complications rate and optimal postoperative patient condition.

Is low back pain a common problem;
Yes. Epidemiological studies have shown that up to age of  20,  a 50% of the population has experienced low back pain. The percentage  reaches 80% at the age of 60 years and is second in frequency after the common cold.
What are the most common causes of back pain;
In most cases, studies have shown that the most common diagnosis is the "non-diagnosis ''. Most cases are unspecifically named as "degenerative disease of the spine." More specific diagnoses are compression vertebral fractures (eg. in the case of osteoporosis), spondylolisthesis, - in the case of younger and older age groups, tumors, as ankylosing spondylitis and inflammation. About 2% are diagnosed with comorbid symptomatology of the sciatic nerve, which reflects the respective leg.
What is the natural progress of low back pain;
In most cases the pain is self-limiting. The problem, however, still remains, and because of incorrect initial diagnosis and other reasons, the symptoms recur. The recurrence time is not known and in many cases is part of the disease progress itself.
Is there a way to prevent recurrences;
Basically, there has to be made a proper initial diagnosis. General principles, regardless of the underlying pathology, is education on the right motor model and feedback, so that through them, the patient can learn the right attitude to not burden his back. Also special exercises, such as the strengthening the trunk (abdominal-dorsal) and muscle stretching exercises of the back and hamstrings. Moreover, the application of cold and hot pads can help. As medication, the antiinflammatory medication therapy is suggested (NSAIDS).
Is there really any correlation of low back pain and imaging findings?
As mentioned above, many defects may contribute to the pathology of the low back pain. However, large studies show there is no statistically significant correlation of imaging findings (simple x-rays) to the underlying pathology and this is often misleading for the doctor and for the patient. It is no coincidence that many times you hear the expression “arthritis” or “degeneration of the spine” but without knowing the exact underlying cause. The reality is that beyond the general classification of the degenerative disease of the spine, it is quite difficult to speak with certainty about the exact underlying cause.
There are more detailed diagnostic tests?
Besides the standard tests such as the CT (CT) and magnetic resonance imaging (MRI), there are other tests such as the bone scan SPECT and the minimally invasive method of discograph. The last, based on personal experience, is common routine in large Clinical Spine Centers abroad such as Guys and St. Thomas Hospital and Kings College of London. Suporters of the  method argue that beyond the help offered in the diagnosis of the disease “discitis” , it is useful to the decision of the kind of surgery, especially when there is integrity of the posterior vertebral elements. In all these cases Khai Lam, one of the leading Spine surgeons , does follow a method of treatment that is  dictated by the results of the discograph.

What is, finally, the most useful tool in the diagnosis of the underlying cause of low lumbar pain?
Whether we believe it or not, the right background and the right clinical examination are those who play the most important role, despite the existence of new expensive technology. The latter is even more important in countries like ours, where the money for treatment and care are on a decreasing trend.
How you preservatively treat  a patient with acute lumbar pain?
A detailed history is essential, by the time the patient enters the Clinic. The analgesic , the anti-inflammatories and the muscle relaxants pills , learning of stationary and lifting objects, learning of proper gait and personalized physiotherapy exercises are in use . In the latter case, there is a disagreement even for starting period of the maneuver. Others claim that the position initiation of any kind of maneuver-physiotherapy is after the first 3 weeks,  while others suggest even earlier. Perhaps the key lies in the type of underlying pathology, and not in the exact time of symptoms onset.
Part of conservative treatment are fluoroscopically guided spinal injections (in the epidural space and the posterior vertebral joints), made from specialized Spine surgeons and anesthesiologists.
Lying in bed helps?
Due to revious lack of knowledge, bed rest was recommended by many. Today, having a good knowledge of the international literature, multicenter studies have shown that patients have the best results when they follow a normal activity and not when they lie in bed. So , it is advised to follow a modest and relaxed activity, avoiding those movements that aggravate the pain.
As for the surgical treatment,  is there any different today?
First we must conclude if the patient needs surgery and if he benefits from this. If , therefore,  we decide that our patient will benefit from surgery,  then new techniques make it easier for the patient. Minimal Invasive Methods , such microdiscectomy ( with or without the use of surgical microscopy), MISS TLIF, PLIF and XLIF techniques, are associated with minimum complications such as intraoperative blood loss and the patient's hospitalization lasts  1 or at most 2 days.
This surgery is performed by an  orthopedic or a neurosurgeon?
In countries such as England, Switzerland, America and others, in short, in countries that have theoretically a good level of training for their doctors, such a question would not have been able. In all these countries there is officially the Spine Surgeon, who may be either  Orthopedic Surgeon or Neurosurgeon and does exactly the same work.

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CONTACT

Dr. Stylianos N. Kapetanakis

Orthopedic and Spine Surgeon MD, FRCS, PhD
Priv. Consultant Spine Surgeon
Ass. Professor at Medical School of Democritus University of Thrace

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