Neurosurgeons Get to the Root of the Problem When Treating Patients for Low Back Pain

Newswise — Seventy-five to eighty five percent of all people will experience some form of back pain during their lifetime. Back pain is the second most frequently reported reason for visiting a doctor, the fifth most frequent cause of hospitalization, and the third most frequent reason for surgery. Low back pain is a topic of interest for the First Annual Neurosurgery Awareness Week, May 1 to 6, 2004, during the Annual Meeting of the American Association of Neurological Surgeons in Orlando, Florida.

Sometimes the pain is a persistent ache in the lower back. For others, the pain shoots down the legs to their muscles. What causes the pain? Surprisingly, the back pain is often caused by irritation of a nerve root near the spine, not muscles, ligaments or bones.

"If a nerve that travels from the spinal cord through the bones of the spine gets pinched or irritated, the muscles tense up and the patient experiences low back pain," said Robert F. Heary, MD, a New Jersey neurosurgeon and AANS member. "The treatment solution depends on why the nerve was irritated in the first place."

The highest rate of back pain occurs in the 45- to 64-year-old age group. Although the incidence of overall back pain is similar in men and women, men are more likely to experience low back pain than women, while women are more prone to upper back pain.

Although low back pain can be debilitating, in 90 percent of the cases the pain improves without surgery. However, 50 percent of all patients who suffer from an episode of low back pain will have another occurrence within one year. Activity, stress, or a mechanical problem in the spine can cause one of the discs in the back to bulge and become misshapen. When this happens, the disc may pinch or put pressure on a nerve root, and the patient experiences pain, which is what frequently happens in a mild or moderate case of low back or leg pain.

Mild cases of low back pain can be treated with rest or anti-inflammatory medications such as aspirin or ibuprofen. Sufferers are often advised to lose weight, walk 30 minutes a day a few times weekly, or do stomach-strengthening exercises such as sit-ups.

If the pain occurs with a fever or follows a specific injury such as a car accident, sports injury, or fall, a patient should call his or her primary care physician or visit the emergency room. Otherwise, see if the pain improves after two or three days of rest or anti-inflammatory medication before calling the physician.

The doctor can do a series of movement tests in the office to determine which nerve root is being irritated, and he or she may then prescribe medication. In addition, a physician may prescribe a course of physical therapy.

Those with more severe cases of low back pain eventually may want to meet with a neurosurgeon. Neurosurgeons are the only physicians who treat the entire spine—both the spinal cord itself and the structures that can exert pressure on the spinal cord and nerve roots. Because neurosurgeons spend about 70 percent of their time treating spine problems and have been trained on diseases of the spine throughout their seven-year residency, they are thoroughly familiar with the treatment options.

The most important thing to remember with back pain is that surgery is one of the many possible solutions the neurosurgeon has. If surgery is recommended, the most common procedure is a discectomy, which involves removing the soft gel-like material from the center of the disc This process returns the disc to a more normal shape, relieving the pressure on the nerve. For more information about low back pain, visit the public Web site of the American Association of Neurological Surgeons at http://www.NeurosurgeryToday.org.

Founded in 1931 as the Harvey Cushing Society, the American Association of Neurological Surgeons (AANS) is a scientific and educational association with more than 6,500 members worldwide. The AANS is dedicated to advancing the specialty of neurological surgery in order to provide the highest quality of neurosurgical care to the public. All active members of the AANS are certified by the American Board of Neurological Surgery, the Royal College of Physicians and Surgeons (Neurosurgery) of Canada or the Mexican Council of Neurological Surgery, AC. Neurological surgery is the medical specialty concerned with the prevention, diagnosis, treatment and rehabilitation of disorders that affect the entire nervous system including the spinal column, spinal cord, brain and peripheral nerves.