Lumbar conditions are spinal conditions that show up in your lower back region and can extend through to your hips, pelvis and down through your legs.
Lumbar Degenerative Conditions
Degeneration of discs, or arthritic changes of your lumbar spine may cause localised back pain, nerve pain in the leg, or spinal deformity. Back pain often radiates to your hips and can extend to the back of your thighs, even when nerves are not involved. The experience of back pain ranges from one-off episodes, to repeated episodes or constant pain.
Arthritis of the lumbar spine causes thickening of ligaments and bone spurs around the joints and discs of the spine. The discs dry out, lose height and in some cases become unstable. These changes can result in nerve pinching or spinal deformity. If a nerve is affected, then there will be shooting pain in the leg associated with weakness, numbness or tingling. Deformity may lead to a stooped or sideways tilted posture, and in some cases back pain and fatigue when trying to walk.
Symptoms of degeneration of the spine usually develop over time.
Early treatment of back pain is based on changing your activity to avoid triggers for pain, anti-inflammatory medication (such as Nurofen, Indocid, Mobic or Celebrex), applying heat packs, and physiotherapy.
Often pain will settle in a few weeks but may recur and be episodic, in which case it is important to try and be active anyway. Nerve pain can be managed in a similar way and cortisone spinal injections are an additional option, but relief from injections is often only temporary.
Lumbar surgery is recommended for unrelenting nerve pain in one or both legs; on occasions, surgery is used to correct spinal deformity. Procedures used to alleviate nerve pinching or deformity vary from simple to complex and the choice will depend upon your spinal symptoms and diagnosis.
Lumbar Disc Herniation and Sciatica
This is also commonly referred to as a disc protrusion, ruptured disc, a slipped disc, disc herniation or a herniated nucleus pulposus.
Irrespective of the name it still refers to common and at times painful lower back condition.
Disc herniation occurs when the tough, outer rim of the disc tears, allowing the soft, central part to squeeze out and contact the nerve that lies adjacent to the disc.
Symptoms include pain in your buttocks and shooting pains down your leg and sometimes the foot, which is known as sciatica. This can be associated with weakness, numbness or tingling of the leg or foot. The onset is usually sudden and typically follows a minor twisting movement followed pain, which can be severe.
In most people symptoms resolve over a few weeks with reduced activity, physiotherapy and medications. Spinal cortisone injections are also an option, though they are not always beneficial.
Surgery is used for unrelenting pain in the leg (sciatica) or severe weakness of the leg. The most common procedure is micro-discectomy via a small incision in the back. Most people having this type of surgery return home after a couple of nights in hospital.
Spinal Canal Stenosis with Claudication
Spinal claudication is heaviness, numbness or pain in your buttocks and legs that comes on with walking and is relieved by sitting down. Typically, walking is limited to about 100 metres because of leg pain, which is relieved by sitting for a few minutes and then walking up to the same distance again.
Spinal claudication is caused by degeneration of the lumbar spine with narrowing of the central spinal canal so that the spinal nerves are squeezed tight. Spinal movements associated with standing and walking further squeeze the nerves and generate symptoms; whereas sitting or bending forward opens the canal and relieves leg pain.
Spinal claudication develops slowly over time and early treatment may include weight loss and maintaining exercise, such as hydrotherapy or on the exercise bike. Anti-inflammatory medications may also help. Spinal cortisone injections are usually of temporary help only.
Surgery is generally recommended when claudication is persistent and disabling. Procedures may vary from simple decompressions to more complex fusions, depending on the underlying condition found on scans. Length of stay in hospital is from two to several nights.