Low Back Pain & Leg Pain

Low Back Pain and Leg pain :: Lumbar Disc Herniation :: Lumbar spinal stenosis :: Spondylolisthesis :: Spondylolysis (Pars Defect)

Low back pain is very common and is one of the most common reasons patients visit their doctor.It is estimated that roughly 80% of the US population experiences low back pain at some time in their lives.

The good news is that most cases of acute low back pain (acute meaning pain that has been there for less than a month) resolves on its own within 6 weeks. If you develop low back pain, try to stay as active as you can, and continue your ordinary activities within limits permitted by your pain. Bedrest is a bad idea and should be avoided. It will only weaken your muscles further and cause you more back pain. Over the counter anti-inflammatory medications such as ibuprofen or naproxen can be used, as can Tylenol. During your recovery, try to avoid bending at the waist until your pain improves. Again, most patients with acute low back improve within a few weeks.

Now the bad news. Unfortunately some cases (roughly 10-15%) of low back pain do not improve and persist for longer than 3 months. This is called "Chronic Low Back Pain" and is a difficult condition to treat. Chronic low back pain (back pain present for longer than 3 months) is a difficult condition to treat. Treatment options include physical therapy and exercise, weight loss and activity modification. Other treatment modalities, such as chiropractic treatment, massage therapy and acupuncture, have been shown to have good results in the short-term but questionable long-term benefits.

Imaging tests such as X-rays and MRI may or may not help identify the source of the pain. A common question is whether surgery is helpful for chronic low back pain. Most patient who have no leg symptoms (numbness, pain, tingling radiating down one or both legs) and only have low back pain are generally not treated surgically. This is because in many cases, the cause of chronic low back pain cannot be precisely identified, so the results of surgery for this reason can be unpredictable.

Just because you have arthritis in your spine does not mean surgery will relieve your back pain. Arthritis is very common in the low back, but most people who are walking around with severe arthritis in their spine do not have pain. On the other hand, there are many patients who have severe low back pain who have minimal to no arthritis in their spine. As you can see, this is a tough problem to sort out. Studies have shown that about 30% of patients without any back pain have abnormal discs in their lumbar spine. Also, degenerative changes in at least one lumbar level were found in 35% of patients between 20-39 years of age and in almost all patients older than 60 years of age.

It is very important to differentiate between low back pain and radicular (leg) pain. Radicular pain means the pain or numbness radiates into the buttock, thigh, leg and even down to the foot. A common term used for this is "sciatica". Patients with these leg symptoms often do benefit from surgery if they have failed all conservative treatment options (such as medications, physical therapy, and injections). If the MRI shows a pinched nerve in the low back, and this pinched nerve corresponds to the patients leg pain, then surgical decompresson can lead to excellent results.

On the other hand, patients with chronic low back pain WITHOUT leg pain do not have as good a result with surgery. Extensive research has been done on the topic of surgical management of chronic low back pain. These studies suggest that the success rate of surgery for this problem is around 60-70%, even in well selected patients. When you compare this to the success rate of, say, knee replacement or hip replacement surgery (95% success rate), you can see why surgery for chronic low back pain is controversial. At least 1/3 of patients with chronic low back pain do not improve with surgery.