Most Common Causes of Lumbar Back Pain

Lumbar Spinal Fusion

Table of Contents

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

Recurrent Herniated (ruptured) Disk

Annular Tears in vertebral diskThe 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.  Bulging is an early sign of wear and tear of the disk. A ruptured disk is when the nucleus pulposus pushes through an annular tear. Even a small amount of disk material in a small spinal canal can cause significant symptoms by pressing on the nearby spinal nerve causing weakness, numbness, and pain all along the nerve. The amount of pain can range from mild to severe and be made worse by walking, bending, lifting, sneezing, coughing, and straining.

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


Spondylolysis is a fracture or defect of the vertebrae and is found most often at the fifth lumbar vertebra.  This defect is thought to be due to a stress fracture. For people with frequent and significant episodes of disability related to spondylolysis, surgery to fuse the fracture may be recommended.  The defect is common in female gymnasts, power weight lifters, and football linemen.


As part of the aging process, the intervertebral disks lose some of their water content. They become stiff and flatten, losing their ability to act as shock absorbers. The vertebrae become unstable and slip back and forth irritating the nearby nerves. Instability can also result from bone tumors or infection of the vertebrae.

Spinal Stenosis

Bone spurs on vertebral diskSpinal stenosis is a narrowing of the spinal canal or of the nerve root openings. The narrowing may result from bone spur formation, soft tissue encroachment, or both. This narrowing may put pressure on the nerves or spinal cord, causing back and leg pain. In addition to surgical removal of structures that are causing the pressure, spinal fusion helps relieve pain.


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) resulting in a pinched nerve. Spondylolisthesis is classified as developed or acquired. Developed happens over time from an abnormal architecture of the spine. Acquired spondylolisthesis occurs after a significant injury and is graded I through IV. Spondyloptosis is a vertebra that has completely slipped over the edge of the lower vertebra. There are several causes for the slip. Some slips are due to simple wear and tear of the bone, others are due to injury. Sometimes a hairline fracture allows vertebrae to slip forward on top of each other. Still others are thought to be related to inherited bone variations. The more significant the slip the more likely the fusion will all require instrumentation.

Other reasons for spinal fusion include treatment of a fractured (broken) vertebra or correction of a deformity.


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

  2. 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.

  3. amandeep sangha says

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

  4. 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?

  5. 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.

  6. 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!

  7. 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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