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Back Pain | Sciatica | Leg Pain

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More than 80 percent of people have at least one episode of low back pain during their lifetime.

Low back pain is described as "acute" (lasting four weeks or less), "subacute" (lasting 4 to 12 weeks), or "chronic" (lasting more than 12 weeks).

If your episode of back pain resolves, you do not need to consult unless you have specific questions or concerns. If you do, we will be happy to advise you.


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Low back pain can be caused by problems with the muscles, ligaments, discs, bones (vertebrae), or nerves. It is often caused by strains or sprains involving the muscles or ligaments. These problems cannot always be seen on imaging tests such as MRI or CT scans.


WHEN IT IS IMPORTANT TO SEEK HELP

Most of the time, an episode of back pain will improve on its own and does not require investigation or treatment.
Many people with low back pain can be adequatelybe evaluated and managed by a primary care provider or physiotherapist.
If low back pain is caused by a serious condition, assessment by a spinal surgeonis usually recommended.


It's a good idea to see your healthcare provider if you have:

  • Pain spreading into the lower leg, particularly if accompanied by weakness of the leg.
  • New back pain if you are 70 years or older.
  • Pain that does not go away, even at night or when lying down.
  • Weakness in one or both legs or problems with bladder, bowel, or sexual function can be signs of cauda equina syndrome, which results from compression of the nerve bundle at the base of the spine. These symptoms should be evaluated as soon as possible.
  • Back pain accompanied by unexplained fever or weight loss.
  • Back pain with a history of cancer, a weakened immune system, osteoporosis, or the use of corticosteroids for a prolonged period.
  • Back pain that is a result of falling or an accident, especially if you are older than 50 years.
  • Back pain that does not get better within a few weeks.

NONSPECIFIC BACK PAIN

Most have "nonspecific" low back pain, which means that the pain is not clearly caused by a specific or identifiable abnormality.
This often represents a strain of the muscles in the lower back, which can be severe.

  • Typically, it improves on its own within a few weeks
  • Apply heat and avoid prolonged bed rest
  • A return to being active as soon as you feel able can help speed your recovery.

Sciatica / Lumbar Radiculopathy

Sciatica is the symptom of shooting or radiating nerve pain that generally begins in the lower back or buttock(s) and spreads down the leg(s). 

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Lumbar Disc Prolapse / Herniation

Your spine is made of 24 moveable bones called vertebrae. The lumbar (lower back) section of the spine bears most of the weight of the body. 

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Lumbar Canal Stenosis / Neurogenic Claudication

Spinal stenosis is a condition in which the central vertebral canal, through which the lumbar nerve and Cauda Equina pass, is narrowed. 

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Spondylolisthesis / Spondylolysis / Pars Defects

Spondylolisthesis is a condition in which one vertebrae of the spine "slips" forward in relation to another. It is usually degenerative and develops in part due to facet joint arthropathy. 

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Serious Potential Causes - Rare
Disc Degeneration,
aka "Degenerative disc disease"
Osteoarthritis / Degeneration
/ Spondylosis
Bulging and Herniated Discs
Spondylolisthesis
Lumbar spinal stenosis
  • Cauda equina syndrome is a rare and severe type of spinal stenosis where all of the nerves in the lower back suddenly become severely compressed. Symptoms can include sciatica on both sides. Weakness or numbness in both legs that is severe or getting worse. Numbness around or under your genitals or around your anus.
  • Spinal Infection
  • Spinal Tumor
  • Compression Fractures - Consider in patients likely to have Osteoporosis
The intervertebral discs have a leathery outer layer termed the annulus fibrosus and a softer jelly-like central component termed the nucleus pulposus. The slowly progressive degenerative process results in the gradual mechanical deterioration of both. The central nucleus polposus slowly loses its ability to hold onto water, becomes increasingly dehydrated, and reduces in volume and height. Fissures can appear within its substance.

The outer annulus, which is made up of sheets of fibres in varying orientations, is, in health, extremely strong and able to contain the nucleus even when placed under significant pressure. With time, however, the fibres of the annulus also deteriorate.

Calling this deterioration a "disease" is somewhat misleading because these changes occur with normal ageing. While the changes in the discs can cause back pain, there are many people with disc degeneration who have no symptoms.
Osteoarthritis tends to degrade the joints that connect the vertebrae to one another. 
These joints are called the facet joints. This condition, known as Facet Joint Arthropathy, can lead to bone spurs around the joint and may cause lower back pain. 
However, like degenerative disc disease, facet joint arthropathy is very common with ageing, and many people with this condition have no symptoms.
As the fibres of the annulus deteriorate, they can become incompetent. The stretching or tearing these fibres can result in the disc bulging or herniation of the central nuclear material out of position, which people often refer to as a "slipped disc." 

A lumbar disc bulge or herniation can then press on the lumbar nerve roots, resulting in pain radiating down the leg.  This radiating leg pain is often called ‘Sciatica’. When the compression is severe the pain a=can be accompannied by weakness, and sensory disturbance or numbness. A very large disc prolapse can cause 'Cauda Equina Syndrome."

NB—Herniated discs are also commonly seen on MRI Scans of adults without back pain, so not all disc herniations require treatment.
Spondylolisthesis is a condition in which one of the vertebrae "slips" forward in relation to another. 
Spondylolisthesis can be due to degeneration and facet joint arthropathy. 
Other causes of Spondylolisthesis involve a mechanical bony defect resulting in the slip - The so-called ‘Pars Defect’.
Spinal stenosis is a condition in which the central vertebral canal, through which the lumbar nerve and Cauda Equina pass, is narrowed. This narrowing is usually due to a combination of degenerative processes, including;
  • Thickening of the internal ligaments (Ligament Hypertrophy)
  • Facet Joint Arthropathy (leading to Facet Joint Hypertrophy)
  • Disc Bulging / herniation
Symptoms commonly described include back and leg pain when standing upright or walking. Associated sensory disturbance is not infrequent. These neurological lower limb symptoms that are precipitated by walking are termed Neurogenic Claudication.

When should I seek medical attention?

  • Pain following severe Injury.
  • Severe pain
  • Numbness or weakness in your arms or legs
  • Diminished control over your bladder or bowels
  • Pain that doesn't get better after you treat it at home for few weeks.

Diagnosis

Many people do not require tests at the time of initial assessment for Low Back Pain. Your symptoms will be discussed, and the back and leg nerves will be examined.

But some people will require tests including:

  • X-ray, CT scan, MRI scan, or other imaging tests
  • Blood tests
  • Neurophysiology - An electrical examination of the Nerve / Muscles.

HOW TO CONTACT DR. BYRNES

If you would like an appointment or have a query, please get in touch by emailing or filling out the form below.

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NEUROSURGERY CLINIC
MEDICLINC PARKVIEW HOSPITAL
AL BARSHA SOUTH
DUBAI, UAE.
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