Lower back pain
ANATOMY OF THE SPINE
The human spine is formed by individual vertebrae and connective tissue discs in between. The vertebrae form the spinal canal. There are seven cervical, twelve thoracic, and five lumbar vertebrae. The intervertebral discs are the link between the individual vertebral bodies.
Normal anatomy of the spine. Longitudinal section and cross sections through the cervical, thoracic and lumbar spine.
The little joints that link the vertebrae together are known as facet joints. They help to stabilize the spine and, together with the intervertebral discs, allow a certain degree of mobility of the spinal cord. The spinal canal should be wide enough to allow nerve roots to float freely in cerebrospinal fluid.
The front border of the spinal canal is built by the vertebral bodies and intervertebral discs, the side by the intervertebral joints (facets) and back by the ligamentum flavum (yellow band) and vertebral arches. Discs consist of an outer fibrous ring (annulus fibrosus), which surrounds an inner gel-like center (nucleus pulposus).
The spinal cord and nerve roots lie within the spinal canal. The spinal cord extends downwards approx. to the 1st lumbar vertebra. Below, only nerve roots are present in the spinal canal. At the level of the intervertebral disc the nerve roots pass through the neural root foramina to exit the spinal canal. The spinal cord and nerve roots conduct electric-like signals from the skin and joints to the brain, and process of movement is initiated from the brain to the muscles.
Facet joint syndrome (vertebral joint arthrosis) is a chronic pain syndrome originating from the small joints between the vertebrae. The facet syndrome falls into the category of wear-related (degenerative) diseases of the spine. The cause of facet syndrome is most often due to an age-related loss of height of intervertebral discs and associated overload of the facets.
Lower back pain originating from the intervertebral joints is called lubmar facet joint syndrome. Lower back pain is one of the most common causes for people to seek medical advice.
CAUSE OF SYMPTOMS
Gradually progressing inflammation and degeneration in the intervertebral joints in the lumbar spine
SYMPTOMS AND SIGNS
Pain and stiffness in the lower back
Leg pain (pseudoradicular type)
THE DIAGNOSIS IS BASED ON Medical history Clinical exam
Facet joints block
and at least one of the following tests: Magnetic resonance imaging (MRI) Computer tomography
The treatment may be non-surgical or surgical.
Non-surgical treatment may include Physiotherapy Physical exercise
Strengthening the back muscles Treatment with heat (Fango) Nonsteroidal anti-inflammatory drugs Muscle relaxants Antidepressants
WHEN SHOULD AN OPERATION BE PERFORMED?
At least 2 months of conservative treatment cannot relieve pain significantly
WHAT IS THE GOAL OF SURGERY?
To destroy the nerve endings that carry the pain from the facet joints
HOW IS SURGERY PERFORMED?
Percutaneous radiofrequency thermoablation
Endoscopic radiofrequency thermoablation
WHICH OTHER DISEASES SHOULD BE EXCLUDED (DIFFERENTIAL DIAGNOSIS)? Tumor of the spine Vertebral fractures Infections and inflammations of the spine
Diseases of the hip or knee Sacroiliac joint pain Disc herniation Arthritis
The condition is treated by medical spetialists in the field of: