Backache

The causes of low back pain are mostly due to strain, posture disorders, congenital curvatures of the spine, lumbar shift, calcification, narrowing of the spinal canal. In addition to these, infections in the lumbar region, various rheumatic diseases and cancers can be counted.

Lumbar Disc Herniation (Lumbar Hernia)

Lumbar hernia, which is one of the most common causes of low back and leg pain, occurs as a result of degenerative changes in the discs between the vertebrae. Since the discs are in a cartilage structure, the forcing forces applied here or the ruptures that occur will cause herniation over time and blunt pains will be felt in the lumbar region.

Risk Factors for Lumbar Hernia

 • Irregular lifestyle, poor diet, smoking and alcohol use

• Decrease in the amount of water in the discs as they age

• Overexertion and poor anatomical posture

• Blunt traumas

• Heavy lifting and sudden movements

Lumbar Hernia Diagnosis

A disc herniation is diagnosed as a result of the examination, laboratory tests and radiological imaging methods to be applied to the patient who goes to the doctor with the complaint of severe low back pain. In some cases, neurological examination and EMG also help the diagnosis.

Lumbar Hernia Treatment

Simple low back pain is relieved with rest and painkillers, and some treatment principles are applied in chronic pain.

Back hernia treatment can be provided by applying anti-inflammatory drugs, muscle relaxants, spinal injection, physical therapy methods. If the patient does not respond to all these, surgical treatment should be considered.

In order to prevent lumbar hernia before it occurs, it is necessary to change the lifestyle and avoid excessively challenging movements on the lumbar region.

Degenerative Disc Disease

Degenerative disc disease occurs as a result of the deterioration of disc tissue. This disease, which is completely different from herniation, can be easily recognized by showing symptoms on radiological images.

Among the causes are substances such as decreased water content in the disc, various infections, smoking, and hereditary predisposition. Of these substances, it is very important to reduce the water content in the disc. Because the amount of water that decreases with ageing will lead to easier deterioration of the discs.

The most common finding in degenerative disc disease is excruciating pain in the lower back and legs. These pains do not go away with changing positions or resting. It negatively affects daily life.

Treatment

In degenerative disc disease, low back pain persists for more than 6 months and surgical treatment can be considered if the patients do not respond to physiotherapy and steroid injections.

The main thing to do is to drink plenty of water in daily life and to strengthen the muscles in the waist area in order to avoid getting sick. In addition, overweight patients should be supported to lose weight.

Facet Syndrome

Spinal movement consists of regular coordination of muscles and nerves. We encounter facet syndrome as a result of degenerative changes in the facet joints in the lumbar region. As this creates a weekly mechanical instability, patients will come with low back pain. 15-40% of the entire population complains of facet syndrome.

The main task of the facet joints in the lumbar region; to control the stabilization of the trunk during flexion and extension movements and to provide key-lock compatibility by preventing any sprain in the discs between the vertebrae. These facet joints cannot provide excessive rotational movements while flexed and can easily degenerate. The amount of load that the facet joints in the spine can carry increases as you go down from the top. Since the maximum capacity that can be carried is certain, not overloading will be a good decision for your back health.

How Does Facet Syndrome Occur?

Traumas that cause degeneration and posture disorders such as excessive flexion-rotation movements take place on the basis of facet joint syndrome. This degeneration mostly involves the L4-L5 facet joints. If there is a congenital facet joint anomaly, degenerative changes will occur more easily.

As a result of the degeneration of the disc, the disc space decreases. As a result, the increase in load on the facets explains the main pathology in this disease. Over time, as a result of inflammation, osteophytes and osteoarthritis may form and cause low back pain.

Low back pain experienced in facet syndrome has no specificity for this disease. However, the pain is usually bilateral and does not show radicular spread. The absence of pain in the knees is a guide in terms of diagnosis.

How Should Facet Syndrome Be Treated?

Bed rest is recommended for a few days using analgesics in acute syndrome. It will be useful to use a corset on the lumbosacral region. In cases where there is no response to simple analgesics, opioids can be tried. In addition, facet joint injection and denervation to suitable patients is also very relaxing.Surgical treatment is preferred in patients who do not respond to these applications, but its reliability is very low due to the lack of adequate follow-up.

Spinal Stenosis (Stenosis of the Spinal Canal)

Spinal stenosis, which generally affects older people and occurs as a result of narrowing of the discs between the vertebrae, causes severe low back pain. Since nerves pass through the spinal cord, the main physiopathology in spinal stenosis disease occurs as a result of compression on the nerves as a result of narrowing. Since the decrease in the amount of fluid with aging will lead to calcification in the joints, it worsens the current picture and causes some neurological problems in patients. It causes numbness and tingling in the legs and causes problems in walking. Patients generally say that their complaints increase with exercise and that they only get relief with rest. So how do we know if there is a narrowing in the spinal canal? Spinal stenosis can be easily diagnosed with a simple low back X-ray. Degeneration and narrowing are seen with X-ray, but the most definitive diagnosis is made by magnetic resonance imaging. If necessary, tomography or myelography methods can also be used in advanced cases.

In the treatment of spinal stenosis, methods such as simple analgesics, muscle relaxants and physiotherapy are applied to the patients. If the patient’s pain continues, we provide some relief from low back pain complaints by injecting transforaminal and intraluminal steroids. If the patient continues to have low back pain complaints despite all this, the method of relieving the spine is applied by opening the narrow canal with the surgical treatment method.

Sacroiliac Pain

The sacroiliac region is located between the spine, hips and legs and provides load transfer by balancing the pressure there. Pain in this area is often caused by mechanical problems. The sacrum bone can be fractured as a result of trauma. Sacroiliac pain, a condition that can often be confused with a herniated disc, usually increases with excessive lifting and bending forward. The pain felt in the lower back and around the hips is expressed by the patients. In its diagnosis, simple radiography, computed tomography and magnetic resonance methods, which are radiological methods, are used. In the treatment of sacroiliac pain, analgesic drugs and ice application are the methods applied to patients in the first place. If physiotherapy treatments are not sufficient, steroid injections are made to the sacroiliac regions with local anesthesia. In advanced cases, radiofrequency thermocoagulation therapy is also applied.

Sciatica-Piriformis Syndrome

Sciatic piriformis syndrome is a disease that occurs as a result of compression of the sciatic nerve, the longest nerve in the body, as it passes through the piriformis muscle. The patient’s standard of living decreases considerably and the pain starts from the hip and spreads to the legs. The most prominent feature is a feeling of pain in the hip and numbness and tingling in the legs. Among other causes of low back pain, hip pain increases with sitting on a hard floor and crossing the legs.

Causes of this disease include mechanical trauma to the piriformis muscle, excessive exercise or a sedentary lifestyle, and congenital anatomical disorders.

The diagnosis of the disease can be made easily with simple imaging methods, radiological applications such as magnetic resonance and computed tomography. In the treatment of sciatica-piriformis syndrome, various analgesic and muscle relaxant drugs can be applied as well as exercises that reduce muscle spasms in the body and strengthen the piriformis muscle. Corticosteroid injection to the area with the help of local anesthesia is aimed at reducing acute pain. Botox application may be preferred in patients who do not respond to these treatments. Osteopathic manipulative treatment, BTX-A injections and iontophoresis methods applied in recent years also give very successful results.

Failed Back Surgery Syndrome

As a result of the patients’ complaints of low back pain, especially in diseases such as herniated disc, after surgical treatment, the symptoms do not show regression, on the contrary, as a result of further progression, unsuccessful back surgery syndrome is experienced. In the hands of specialist surgeons, the rate of experiencing failed back surgery syndrome is 3-5%.

So how do we identify patients who have had unsuccessful back surgery?

• Recurrent hernias as a result of not cleaning the disc space well during hernia surgeries cause patients to experience low back pain later on.

• Patients may experience spinal stenosis along with herniated disc. If no intervention was made for spinal stenosis during the operation, the patient will complain of low back pain again after the operation.

• Even if herniated disc surgery is successful, new hernias, spinal stenosis or slipped back may occur later on.