Causes of low back pain

Let’s have a look a the causes of low back pain and how it could be related to and .

  • common complaint among adults
  • lifetime prevalence in working population up to 80%
  • 60% experience functional limitation or disability
  • second most common reason for work disability
  • despite advances in imaging and surgical techniques LBP prevalence and its cost are relatively unchanged
  • 90% people age >50 have Degenerative Disc Disease
  • Large disc does NOT always need surgery
  • Neurologic loss is NOT an absolute indication for surgery
  • Small disc bulge is NOT always normal
  • Surgery does not have an 80% success rate
  • Conservative treatment is reversible. Surgery is not.

 

Cause of low back pain

Causes of low back pain - Click to enlarge

Back pain causes:

 

Disc Degeneration

Normal Vs Disc Degeneration - Clic to enlarge

Disc degeneration (arthrosis)

  • Changes in hydrostatic
  • Lack of oxygen
  • Lack of glucose
  • Changes in pH levels
  • Death of proteoglycans

If the cells of the disc failed to get proper nutrients – such as oxygen, or glucose – or if the pH level of the disc drops (because waste is not being diffused out of the disc and it becomes anaerobic), disc cells would die and stop producing the vital proteoglycan aggregates. The disc loses its water content (dehydrates) and loses its hydrostatic pressure (osmotic pressure).

Symptoms of are the result of either herniation of the through a mechanically weak annulus fibrosis or from tearing of the annulus itself. This can lead to Radiculopathy from and/or Radiculitis – an inflammatory process affecting or the spinal cord.  Herniation is thought to be the result of a defect in the annulus fibrosis, most likely the result of excessive stress applied to the disc.


Herniated disc

Three types of annular tears:

  1. Rim lesion – horizontal tearing of the very outer fibers of the disc near their attachments into the ring apophysis;
  2. Concentric tear – splitting apart of the lamellae of the annulus in a circumferential direction
  3. Radial tear – horizontal or obliquely horizontal tears

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