Low back pain is not simple

Low back pain is a common clinical symptom with many causes. In severe cases, it can affect life and work. For young and middle-aged people with low back pain, attention should be paid to rheumatoid spondylitis, spinal tuberculosis and spondylotic osteochondritis. For the elderly, proliferative spondylitis, spinal osteoporosis, and spinal metastatic cancer are common. For female patients with lumbar pain, pelvic inflammatory disease, abnormal uterine position, or urinary system diseases should be considered. Miners, porters, actors, athletes, and desk workers are prone to chronic low back pain. When lumbar disc herniation, spinal tuberculosis, or spinal tumors compress the nerve roots, radiating pain often occurs in the back of one or both lower limbs. Low back pain is closely related to body position when the kidney is ptotic.

Let’s take a look at some common diseases that cause low back pain:

1. Acute lumbar muscle strain

It is more common in young and middle-aged people with a history of overload or sports activities. When injured, the patient may suddenly feel a sound in the waist and immediately have severe waist pain on one or both sides, and may have radiating leg pain. Physical examination can show tension in the waist muscles, tenderness on the inner side of the posterior superior iliac spine, and beside L4-5. Imaging examination can rule out the possibility of vertebral compression fracture or transverse process fracture.

2. Chronic lumbar muscle strain

It manifests as chronic intermittent or persistent pain around the lumbar muscles. The pain worsens when tired and improves after rest. The pain can last for a long time and is sometimes related to the weather. Physical examination may show mild impairment of lumbar movement, no scoliosis deformity of the spine, and tenderness at the L3 transverse process. Imaging examination can exclude the possibility of other accompanying conditions.

3. Lumbar Degeneration

It is more common in elderly patients. The pain can be mild or severe, and is usually continuous. Symptoms may worsen with changes in body position, and some may be accompanied by radiating pain in the legs. Imaging examinations show that the lumbar curvature becomes straight, the sequence is irregular, the vertebral margins have lip-like hyperplasia, some have bone bridge formation, some are accompanied by small joint mutation apex hyperplasia, and some intervertebral spaces are narrowed, with L4-5 and L5-S1 intervertebral spaces being the most common.

4. Lumbar disc disease

It may be a herniated, bulging or prolapsed intervertebral disc. Most cases have low back pain, with or without radiating pain in the legs. Actions that increase cerebrospinal fluid pressure, such as coughing, sneezing, and defecation, and actions that strain the sciatic nerve, such as bending over and raising the legs straight, can aggravate the pain or produce electric shock-like radiating pain. Imaging examinations can show narrowing of the intervertebral space, protrusion or prolapse of the intervertebral disc into the spinal canal behind the vertebral body, or bulging to the surrounding area, and signs of arc-shaped compression of the dura mater.

5. Ankylosing Spondylitis

Lumbar pain is the earliest and most common symptom. The lumbar joint is stiff and limited in movement in the morning. The lesion progresses upward, involving the thoracic and cervical vertebrae, causing chest and back pain, limited head movement, and complete ankylosing and stiffness of the spine. Imaging examinations show that the sacroiliac joint space is blurred, the joint surface has worm-like destruction, some joint spaces disappear, joints are fused and ankylosed, and ligament ossification can be seen in the spine, showing bamboo-like changes. Some patients have hip joint involvement.

6. Tuberculosis of the lumbar spine or sacroiliac joint

Patients often have local distending pain, dull pain or soreness, which is generally mild. Movement, coughing, sneezing, etc. can aggravate the soreness. Imaging examination of lumbar tuberculosis can show bone destruction of adjacent vertebrae, narrowing of intervertebral spaces, kyphosis, and formation of paravertebral abscesses. Sacroiliac joint tuberculosis can show destruction of articular surfaces, irregular narrowing of intervertebral spaces, surrounding cold abscesses, or formation of sinus tracts.

7. Spinal Tumors

It can be divided into primary and metastatic tumors. Most of them are metastatic tumors. Common metastases are prostate cancer, thyroid cancer, breast cancer and kidney cancer. It can also be multiple myeloma. The pain is severe and continuous. Imaging examinations can show multiple vertebral bone destruction or sclerosis, which can be diagnosed in combination with primary cancer.

8. Congenital spinal deformity

Occult spina bifida, lumbar sacralization, sacral lumbarization, spondylolisthesis, asymmetric lumbosacral joint, etc. Imaging examination can confirm the diagnosis.

X-rays should be taken if the following symptoms occur during the initial visit to the doctor for low back pain:

(1) Severe night pain or rest pain

(2) Fever above 38°C for more than 48 hours

(3) Progressive neurological loss

(4) Pain accompanied by numbness of the extremities or weakness of the lower limbs

(5) Loss of bowel and/or bladder control (retention or incontinence)

(6) Clinical suspicion of ankylosing spondylitis

(7) Clear history of trauma

(8) Suspected or confirmed malignant tumor

(9) Osteoporosis

(10) Long-term oral nonsteroidal hormone therapy

(11) Immunosuppression or immunosuppressive therapy

(12) Drug and alcohol abuse

(13) Further imaging studies are only required in the following situations

(14) Progressive neurological loss

(15) After 6 weeks of conservative treatment, the radiculopathy symptoms did not improve or were minimal.

(16) Uncontrollable pain

(17) Multiple nerve root involvement

Low back pain is just a symptom. Most people will experience low back pain in their lifetime. If you are troubled by low back pain, you should seek medical attention in time and seek professional help as soon as possible to relieve the problem.

Recommended Doctors

Yang Xiaoxia, attending physician of the Department of Spine, the Third Affiliated Hospital of Beijing University of Chinese Medicine

He specializes in endoscopic spinal surgery for lumbar disc herniation and lumbar spinal stenosis; percutaneous minimally invasive treatment and open surgery for cervical spondylosis, spinal injury, and lumbar spondylolisthesis; diagnosis and drug treatment of osteoporosis; and conservative treatment of spinal-related diseases using a combination of Chinese and Western medicine.

Source: Official WeChat Account of Beijing Third Hospital of Traditional Chinese Medicine