Pain in the lower back (the lumbar spine) is one of the most common symptoms people experience, and most of us will have some degree of back pain at one point or another. Although it can be worrying and uncomfortable, the great majority of episodes settle with time and simple measures, and only a small proportion of people ever need surgery.
There are a number of structures in the spine that can produce pain. These include the small joints at the back of the spine (the facet joints), the discs at the front that sit between each vertebra, the surrounding muscles and ligaments, and occasionally the nerves themselves. Because so many structures can be involved, identifying the source of the pain is the first and most important step.
In most cases, lower back pain is mechanical – it comes from the normal wear and tear changes that happen to the spine as we get older, or from a temporary strain. Common contributing factors include:
It is worth remembering that pain levels do not always reflect the seriousness of the underlying cause. Severe pain is very often the result of something entirely benign that will settle in time.
A careful history and clinical examination are the most valuable tools in understanding back pain. Talking with a specialist, being examined, and being offered reassurance and a clear explanation for why the pain is there can in itself be a significant part of treatment.
Imaging such as an MRI scan is not always necessary, and is most useful when the history and examination suggest a specific cause that may need treatment, or where symptoms have not settled as expected. Scans are recommended on a case by case basis rather than routinely, as findings such as wear and tear are extremely common and do not always explain a patient’s symptoms.
The majority of episodes of lower back pain can be managed conservatively – that is, without surgery. This typically involves staying active within comfortable limits, simple pain relief, and physiotherapy to build strength and confidence in the back. Keeping moving, rather than resting completely, is usually the right approach and helps recovery.
Where pain is more persistent, other measures such as targeted injections may have a role. Surgery for back pain alone is uncommon and is only considered in specific circumstances, usually where there is a clear structural problem that matches the symptoms and has not responded to other treatment. The aim is always to recommend the least invasive approach that is likely to help.
It is sensible to seek a specialist opinion if your back pain is severe, is not improving after several weeks of conservative treatment, or is associated with pain, numbness or weakness travelling down the leg. You should seek urgent medical attention if you experience any difficulty controlling your bladder or bowels, numbness around the back passage or inner thighs, or progressive weakness in the legs, as these can occasionally be signs of a more serious problem.
As a Consultant Neurosurgeon in Cambridge, Mr Dan Brown is able to assess your back pain, explain clearly what is causing it, and guide you towards the most appropriate treatment – which in most cases will not involve surgery. Where surgery is appropriate, his neurosurgical training means complex spinal problems can be managed with care and precision. You can read more about his spinal surgery in Cambridge.
In most cases, no. The great majority of back pain settles with conservative treatment such as physiotherapy and pain relief. Surgery is only considered in a small number of cases where there is a clear structural cause that has not responded to other measures.
Not always. A scan is most helpful when your history and examination point to a specific cause that may need treatment. Wear and tear changes are very common on scans and do not always explain symptoms, so imaging is recommended on an individual basis.
Staying gently active within comfortable limits is usually better than complete rest, and tends to help recovery. Your specialist or physiotherapist can guide you on what is appropriate for your situation.
Both can treat spinal conditions. A neurosurgeon has particular training in the spinal cord and nerves, which can be especially relevant where pain involves the nerves or where the problem is more complex. The most important thing is a careful assessment and the right treatment for you.
