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Most Common Causes of Lumbar Back Pain

Back Pain

Approximately 90% of individuals will have an episode of back pain at some point in their lifetimes.  Of these 90%, approximately 50-60% individuals will have recurrent back pain.  Bottom line, back pain is very common. Most importantly, 90% of the time, back pain will resolve by 6 weeks.  

That being said, while most back pain is benign, it is important not to ignore your symptoms.  In particular, if your back pain is associated with sciatica type pain (pain down the legs), new onset bowel or bladder incontinence (difficulty with controlling your bathroom habits), numbness, difficulty walking, or any other concerning symptoms, it is important to seek medical help.

There are numerous causes of back pain. A few of the more common causes of back pain are discussed below:

Herniated (ruptured) Disk

The disk is composed of two parts; the soft center (nucleus pulposus) and the surrounding tough, fibrous outer ring (annulus). A herniated disk is one in which the tough outer ring tears (annular tears ) and allows the soft center to protrude or bulge through the tear.  

Even a small amount of disk material in the spinal canal can cause significant symptoms by pressing on the nearby spinal nerves. This can lead to weakness, numbness, and sciatica type pain. Pain also can be referred to the back. Pain can be mild to severe and be made worse by walking, bending, lifting, sneezing, coughing, and/or straining.

The two most common levels of disk herniation are at L4-L5 and L5-S1.

Annular Tears in vertebral diskSpondylolysis

Spondylolysis is a fracture or defect of the pars interarticularis, an area of the bone in the posterior vertebra. It most commonly occurs at the L5 vertebra.  This condition is thought to be due to a stress fracture and is common in female gymnasts, power weight lifters, rowers, and football linemen.

For individuals with frequent and significant episodes of disability related to spondylolysis, surgery to fuse the fracture may be recommended.  

Degenerative Disc Disease

As we age, the discs in our back lose water content and begin to break down.  They become stiff and flatten, losing their ability to act as shock absorbers.  The end result of this is that the surrounding anatomy begins to see increased load and ultimately becomes arthritic.  As the normal anatomy becomes distorted, this can also lead to instability in the spine. Unstable vertebrae can slip back and forth irritating the nearby nerves (this is called degenerative lumbar spondylolisthesis).

Even in the absence of instability, as arthritis progresses, bone spurs and overgrowth of ligaments can lead to pinching of nerves (called lumbar spinal stenosis). 

Spinal Stenosis

Bone spurs on vertebral diskSpinal stenosis is a narrowing of the spinal canal or of the nerve root openings (neural foramen). The narrowing may result from bone spur formation, soft tissue encroachment, or both. This typically occurs as a result of degenerative disc disease.

Narrowing of the spinal canal or the neural foramen may put pressure on the nerves or spinal cord, causing back and leg pain.

Based on the severity of the symptoms, surgical removal of the impinging structures (called a decompression) may be necessary to help relieve symptoms.  Depending on the condition of your spine e.g. if there is any underlying instability, in addition to surgical removal of structures that are causing the pressure, spinal fusion may be warranted. 

 

Spondylolisthesis

Forward slip of one vertebra on top of another

Forward slip of one vertebra on top of another

Spondylolisthesis is a forward slip of one vertebra on top of another (which can occur at any level). This slippage can lead to back pain or pinching of nerves, which can cause leg symptoms. 

Spondylolisthesis can result from an underlying abnormality of the normal spinal anatomy.  Slips can also occur from long standing arthritis or even due from injury. Sometimes a hairline fracture allows vertebrae (i.e. spondylolysis) to slip forward on top of one another. 

If significantly symptomatic, spondylolisthesis may be treated with spinal fusion. 

 

Other Causes of Back Pain

It is very important to remember that there are many causes of back pain that are not necessarily related to the spine. For instance, problems with the kidney, the gastrointestinal system, or even the major vessels of the body can refer pain to the back.  Therefore, it is important to see your doctor if you are having back pain. 

Note that the information in this article is purely informative and should not be used in place of recommendations from your surgical team. 

Related Articles

Lumbar Spinal Fusion
Most Common Causes of Lumbar Back Pain
Your Visit With The Surgeon
Getting Yourself Ready For Surgery
Understanding Back Precautions
Making Arrangements For Surgery
Your Hospital Visit
Lumbar Spinal Fusion Surgery
Recovery At Home
When To Call Your Surgeon
Long Term Care For Your Back

More Information:

Lumbar Spine Structure and Function

Comments

  1. mike s mai says

    elated to golf injury my L3 & L4 slipped forward and coursing felling numbness on left foot even laying down almost 20 years ago. And caused now a day not able to walk averaged beyond 300 steps due to to much Numbing cause souring and inability to step leg forward. Now already my right leg also showing this kind problem, too. Sitting and using shopping cart to walk (during grosory shopping) have no problem.
    I am weighting 225 pounds at 5’9″, overweighted!
    What is best solution? Loose weight or surgery?

  2. What are alternative treatments to slow or halt progression of pain from L1 spinal stenosis? Tai chi? Yoga?

  3. Michael doolan says

    Have had l5/s1. L4/3 fusion..Now have pain r.leg to foot.MRI showed spinal stenosis at L2/3.can foot pain be caused at this level.

  4. amandeep sangha says

    How to relieve pain from factured vertabre in the lowest disk in lower back

  5. I have severe lower back pain in Lumbar region of my back. MRI RESULTS: Scoliosis and multilevel degenerative disc disease. Canal and foraminal stenosis most significant at L2-3 with moderate to severe canal and moderate bilateral foraminal stenosis. Can a bilateral severe DJD cause this problem? I know if I stand 5 minutes I get severe crippling pain in the lumbar spine. MRI RESULTS:
    RIGHT KNEE: Severe degenerative joint disease. Torn menisci ( Complex degenerative tear of the medial meniscus) Body lateral meniscus also torn . Large osteophytes. Large joint effusion. LEFT KNEE: There is severe degenerative joint disease in all 3 compartments of the knee with a large complex joint effusion with loose bodies. ACL is torn. Complex tears of the medial and lateral menisci. Could my bilateral knee condition be causing the change in the lumbar spine?

  6. Ernie Muschner says

    I have very bad pain in my right foot for about six months now. The pain is located bottom of my instep near my heel. The pain is so bad i have to use crutches. I went to my podiatrist and she gave me a cortisone injection and that did not help. I had a MRI of my right foot done on 03/20/2018 and the doctor called me and said that there where no tears or fractures. She said that my plantar faciitis is mild and i should not be hurting this bad 24/7 with it being mild.
    The doctor thinks that my pain may be coming from my lower back into my foot.
    Any advise i can get please.

  7. Margaux Ford says

    I appreciate it that you talked about the benefit of spinal fusion to relieve the pain caused by spinal stenosis. I’ve been struggling with painful back and leg pain lately, and I’m considering on seeing an orthopedist and get it checked. Thanks for mentioning that surgical removal of structures that are causing the pressure can also help. I appreciate the advice!

  8. In 2007 i lifted and injured my lower back. My physical med doc took an mri and said I had 2 discs involved in my lower back in which 2 were bulging and 1 was protruding to the left thus causing pain in my left hip.
    I had just started physical therapy as the next protocol( after deciding not to have an epidural just yet).
    Well, I moved to the opposite coast and now 8 years later and periods of babying it and then lifting things I should not I have felt the disc actually move a few times and now after another move and lifting and straining things I should not I am not able to make the pain go away even a bit and even turning over in bed is painful in the back of my hip( were kids have dimples) and in my buttock and down leg. I am worried I have waited too long and am not sure if my issue in only spine but also hip. I have health insurance but my copays are not doable to have tons of physical therapy, but to avoid surgery is my goal. Have I done too much damage? Can I get help?

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