What is the lumbar spine?
The lumbar spine refers to the lower area of the spine between the pelvis and thoracic cage. It is made up of 5 vertebrae (although some people may have 6) that are stacked on top of each other with cushion-like intervertebral discs in between. The lower back is the largest movable segment of the vertebral column and is extremely vulnerable to disorders, making it the source of many pain complaints.
What are the symptoms lumbar spine problems?
The different kinds of back pain are universal up and down the spine. The lumbar spine, however, is the area of the spine that is most prone to injury or the effects of aging, which shows itself in acute or chronic pain.
These are typical symptoms:
- Persistent aching or stiffness
- Sharp, localized pain (usually after lifting heavy objects or overuse)
- Chronic ache, especially after sitting or standing for long periods
- Back pain that radiates down into the buttock, the back of the thigh, the calf, and the toes
- Muscle spasms when trying to straighten the spine
What Causes Lumbar Spine Pain?
Pain in the lower back/lumbar spine can originate in the nerve roots exiting the spine, the joints, the discs, the vertebrae, and the muscles. Many times pain will be a result of a combination of factors from different areas, such as when degenerating discs allow for nerve compression.
These are some of the more common causes behind your lower back pain.
- Degenerated discs — The disc between your vertebrae act as shock absorbers and cushions, enabling movement. They are made of a tough outer shell and an inner soft gel. As we age, the discs harden and thin, and this can lead to pain in the disc space.
- Lumbar disc herniation — Due to the forces impacting the lumbar spine, the discs in this part of the spine are under the more pressure. As we age, our discs harden and become less malleable. Force applied due to heavy lifting or from continued wear can cause a disc to herniate, where the outer shell tears and the inner gel pushes outward. This gel can then push on a nerve root, leading to pain.
- Osteoarthritis — This type of “wear and tear” arthritis can cause the cartilage covering the facet joints in the back of the spine to wear. This can produce bone spurs and swelling in the joint. Bone spurs often result in compression of the nerve roots exiting the spine, causing chronic pain.
- Muscular problems — Muscle strains are the most common cause of lower back pain. Heavy lifting, bending, twisting, or heavy repetitive use can strain these muscles. Unlike most of the pain caused by compression and herniation, muscle strains in the back can cause severe pain. Fortunately, they will heal on their own in days or at most a few weeks.
- Lumbar stenosis — If the spinal canal or the nerve root canals (gaps where the nerve endings exit the spinal column) become narrower, this leads to the nerve endings being squeezed. This compression will lead to leg pain, tingling, numbness, and even difficulty walking.
- Spondylolisthesis — When one vertebra moves forward over the one below it, this is called spondylolisthesis, and it can lead to nerve compression that causes pain in the legs and feet. This is most common in the lower lumbar spine, L4-L5 or L5-S1.
- Sacroiliac joint dysfunction — This joint, where the spine connects to the top of the tailbone, can be a source of compression and pain, which usually radiates into the legs.
What Is lumbar spine Surgery?
Dr. Todd Albert may recommend surgery to address a patient’s pain if the pain does not respond to nonsurgical treatments. Surgery is usually not considered immediately, except in the case of severe trauma, but is usually an option after 6-12 weeks of other nonsurgical treatments. Spinal surgery is usually not recommended for mild to moderate lower back pain.
However, if the patient has disc herniation or nerve compression from bone spurs or spinal stenosis, these conditions will likely not improve without surgery. There are two general types of lumbar spine surgery that either aim to decompress the nerve root that is being pinched, or to limit the motion between two or more vertebrae in the lumbar spine that is causing pain.
Here are the procedures Dr. Albert performs on the lumbar spine, with brief descriptions of each. For more detailed information, you can link to each individual procedure page.
Who Is a good candidate for lumbar spine surgery?
The decision to proceed with surgery is a difficult one and is generally up to the patient, based on their individual level of pain and dysfunction. Dr. Albert often recommends that you first attempt to treat the pain related to your spinal problem with conservative treatments such as physical therapy or injections.
However, if your pain doesn’t respond to nonsurgical treatments, surgery may be the only long-term solution to gain relief of the symptoms. Nerve compression, spondylolisthesis and stenosis do not resolve on their own without intervention.
Types of Lumbar Surgery
Lumbar Laminectomy Surgery (PLD)
A lumbar laminectomy (PLD) is performed to relieve pressure on the spinal cord or nerves. The surgery removes a portion of the herniated disc that is pressing on the nerve. This helps relieve the pain and protect against permanent nerve damage.
Microdiscectomy is one of the most common spine surgery procedures. This surgery relieves pressure on the nerve and removes the source of the pain.
Posterior lumbar decompression and fusion (PLDF)
Posterior lumbar decompression and fusion (PLDF) is a surgical procedure that aims to relieve pain and pressure on the spinal cord and the nerves in the lower back.
Transforaminal lumbar interbody fusion (TLIF)
Transforaminal lumbar interbody fusion (TLIF) is a procedure that fuses the anterior and posterior columns of the spine through a posterior approach. This approach results in less disturbance to the nerve roots, reducing the risk of scarring or injury to them.
Are there things I can do to prevent lumbar spine pain?
While exercise is important for overall health, the wrong sort of exercise, such as high-impact exercise, can actually lead to back pain. Low-impact exercise, such as swimming or bicycling, can improve your overall fitness without risking back pain. Dr. Albert would recommend meeting with a physical therapist who can provide direction of strengthening exercises for your abdominal and lumbar muscles, as well as teach you proper mechanics for bending, lifting and twisting.
Schedule a Consultation
If you would like to learn more about lumbar back surgery, call (212) 616-1004 to schedule an evaluation with New York Spine Surgeon, Dr. Todd J. Albert.