Low Back Pain
Low Back pain (LBP) is a very common disorder that affects 65-80% of the world population and huge social importance for the great economic impact resulting. In Italy 4 million people every year come to the doctor for problems related to back pain.
Low back pain is a localized pain in the lower back and can involve the lower lumbar region, lumbosacral and sacroiliac coming to radiate to the lower limbs and, in this case, is called sciatica. When pain occurs suddenly and violently is called “lumbago”.
Low back pain can originate from various causes:
- Traumatic, caused by overexertion or falls that distort or bruises;
- Musculoskeletal for example, a disc disease;
- Visceral disease, abdominal o pelvic can prove through back pain;
- Chronic degenerative diseases such as osteoarthritis of the lumbar spine.
There are two forms of LBP:
- Acute low back pain: recent onset (less than three months), pain is constant and very troublesome;
- Chronic low back pain: when pain persists for more than six months.
SYMPTOMS AND DIAGNOSIS
Pain, difficulty moving (in lean forward) and a contraction of the muscles that support the spine are the most common symptoms. They have more to wake with the first movements or evening because of the tiredness of the day. For those who have a sedentary job, the pain may occur when you get up from the chair, or it can be continuous in the sitting. In the event that the back pain depends on traumatic events, the pain is acute and occurs after an excessive effort or a wrong move. Usually the diagnosis is made by physical examination of the doctor and, when necessary, an X-ray or an MRI of the spine.
Like all other herniations, it is caused by the leakage of content from its natural container. In the case of the hernia to the disk, the “content” is the nucleus of the intervertebral disc, the “container” is the annulus, ie, the outer part of the intervertebral disc that has the task of cushioning the forces that develop within the column between a vertebra and the other.
The true hernia, the risk of surgery, causes a lesion of the nerve roots that emerge from the spinal canal behind the disc. It is recognized because there is cruralgia, that is a pain that runs down the leg to the front, or sciatica, or pain along the rear leg, up to the calf or foot, so if there is pain in the leg , there is not even a hernia significant.
About the causes of this persistent pain the most accepted theory today is that it is in front of a big inflammatory phenomenon of the nerve, caused not so much by the compression, but rather by the release of a whole range of substances contained in the discal nucleus that are highly detrimental to for the nerve.
While the hernia is seen with a CT or MRI examination as, since we now know that about 25-30% of people who have never suffered from back pain, have a hernia, it is understood that the true diagnosis of disc herniation significant can be done only with a visit.
CT and MRI you can only confirm something that the good doctor sees the patient’s bedside. What you see is a loss of strength, sensitivity and reflexes in the legs.
If the pain does not pass, it remains that surgery knowing that this guarantee to remove the bad leg and back pain and that, in the long term, the risk of relapse is the same whether you operate or not just do it. Surgery is invasive, leaving the scars, requires his convalescence, but if he takes off immediately at least the leg pain. Obviously it is the patient to choose, taking into account that in any case, whether you operate either does not do so and the risk of relapse is very high for the next two years. Fundamental is prevention.