The etiology, pathogenesis, clinical presentation and differential diagnosis in Lower Back Pain with comparison of possible methods of treatment
DOI:
https://doi.org/10.12775/JEHS.2024.63.009Keywords
Low Back Pain, disc herniation, lumbar discopathy, radiculopathy, sciatica, RehabilitationAbstract
Introduction and purposeNon-specific and specific lower back pain syndrome is one of the leading causes of musculoskeletal disability and affects more than half of the population worldwide. The aim of this paper is to confront the problem of lumbar pain, possible diagnostic options, conservative and surgical opportunities with long term satisfactory rate.
State of knowledge
The paper reviews literature on lower back pain syndrome, sciatica, radiculopathy and lumbar disc herniation in regards to detection of the problem, classifying it and possible methods of resolvement. The WHO defines lower back pain as one of the leading causes of musculoskeletal dysfunction and it focuses on reducing the occurrence by programs like WHO Rehabilitation 2030 Initiative, UN Decade of Healthy Ageing and others. The paper also focuses on non surgical options of treatment.
Material and methodA review of the literature available in the “PubMed” and Google Schoolar was conducted. We focused on differential diagnosis depending on clinical presentation and possible treatment methods depending on symptoms, pathogenesis of the disorder and available procedures.
Summary
Our review managed to present the current state of development, possible differential diagnosis, prevalence of neural compressions, sciatica and radiculopathy in different diagnostic options. By receiving multiple studies we confront varied opinions of specialists regarding the approach to lower back pain syndrome and favorable forms of care. Additionally we came to the conclusion that the difference of patients' long term satisfactory rate in regards to nonoperative and operative treatment is not significant, and flattens over the years.
References
Kuorinka I, Jonsson B, Kilbom A, et al. Standardised Nordic questionnaires for the analysis of musculoskeletal symptoms. Appl Ergon. 1987;18(3):233-237. doi:10.1016/0003-6870(87)90010-x
Jonsson E, Nachemson A. [Collected knowledge about back pain and neck pain. What we know--and what we don’t know]. Lakartidningen. 2000;97(44):4974-4980.
Waddell G. 1987 Volvo award in clinical sciences. A new clinical model for the treatment of low-back pain. Spine (Phila Pa 1976). 1987;12(7):632-644. doi:10.1097/00007632-198709000-00002
Waddell G, Burton AK. Occupational health guidelines for the management of low back pain at work: evidence review. Occup Med (Lond). 2001;51(2):124-135. doi:10.1093/occmed/51.2.124
Andersson GB. Epidemiological features of chronic low-back pain. Lancet. 1999;354(9178):581-585. doi:10.1016/S0140-6736(99)01312-4
Hirsch C, Jonsson B, Lewin T. Low-back symptoms in a Swedish female population. Clin Orthop Relat Res. 1969;63:171-176.
Heliövaara M, Impivaara O, Sievers K, et al. Lumbar disc syndrome in Finland. J Epidemiol Community Health. 1987;41(3):251-258. doi:10.1136/jech.41.3.251
Nordin M, Welser S, Campello MA, Pietrek M. Self-care techniques for acute episodes of low back pain. Best Pract Res Clin Rheumatol. 2002;16(1):89-104. doi:10.1053/berh.2001.0208
Miranda H, Viikari-Juntura E, Martikainen R, Takala EP, Riihimäki H. Individual factors, occupational loading, and physical exercise as predictors of sciatic pain. Spine (Phila Pa 1976). 2002;27(10):1102-1109. doi:10.1097/00007632-200205150-00017
Gyntelberg F. One year incidence of low back pain among male residents of Copenhagen aged 40-59. Dan Med Bull. 1974;21(1):30-36.
Ahn UM, Ahn NU, Buchowski JM, Garrett ES, Sieber AN, Kostuik JP. Cauda equina syndrome secondary to lumbar disc herniation: a meta-analysis of surgical outcomes. Spine (Phila Pa 1976). 2000;25(12):1515-1522. doi:10.1097/00007632-200006150-00010
Kostuik JP, Harrington I, Alexander D, Rand W, Evans D. Cauda equina syndrome and lumbar disc herniation. J Bone Joint Surg Am. 1986;68(3):386-391.
Olmarker K, Blomquist J, Strömberg J, Nannmark U, Thomsen P, Rydevik B. Inflammatogenic properties of nucleus pulposus. Spine (Phila Pa 1976). 1995;20(6):665-669. doi:10.1097/00007632-199503150-00006
Boos N, Rieder R, Schade V, Spratt KF, Semmer N, Aebi M. 1995 Volvo Award in clinical sciences. The diagnostic accuracy of magnetic resonance imaging, work perception, and psychosocial factors in identifying symptomatic disc herniations. Spine (Phila Pa 1976). 1995;20(24):2613-2625. doi:10.1097/00007632-199512150-00002
Kelsey JL, Githens PB, White AA, et al. An epidemiologic study of lifting and twisting on the job and risk for acute prolapsed lumbar intervertebral disc. J Orthop Res. 1984;2(1):61-66. doi:10.1002/jor.1100020110
Hagen KB, Jamtvedt G, Hilde G, Winnem MF. The updated cochrane review of bed rest for low back pain and sciatica. Spine (Phila Pa 1976). 2005;30(5):542-546. doi:10.1097/01.brs.0000154625.02586.95
Konno S, Yabuki S, Sato K, Olmarker K, Kikuchi S. A model for acute, chronic, and delayed graded compression of the dog cauda equina. Presentation of the gross, microscopic, and vascular anatomy of the dog cauda equina and accuracy in pressure transmission of the compression model. Spine (Phila Pa 1976). 1995;20(24):2758-2764. doi:10.1097/00007632-199512150-00019
Takahashi K, Olmarker K, Holm S, Porter RW, Rydevik B. Double-level cauda equina compression: an experimental study with continuous monitoring of intraneural blood flow in the porcine cauda equina. J Orthop Res. 1993;11(1):104-109. doi:10.1002/jor.1100110112
Olmarker K, Larsson K. Tumor necrosis factor alpha and nucleus-pulposus-induced nerve root injury. Spine (Phila Pa 1976). 1998;23(23):2538-2544. doi:10.1097/00007632-199812010-00008
Scham SM, Taylor TK. Tension signs in lumbar disc prolapse. Clin Orthop Relat Res. 1971;75:195-204. doi:10.1097/00003086-197103000-00026
Podnar S. Bowel dysfunction in patients with cauda equina lesions. Eur J Neurol. 2006;13(10):1112-1117. doi:10.1111/j.1468-1331.2006.01423.x
Podnar S, Trsinar B, Vodusek DB. Bladder dysfunction in patients with cauda equina lesions. Neurourol Urodyn. 2006;25(1):23-31. doi:10.1002/nau.20188
Spangfort EV. The lumbar disc herniation. A computer-aided analysis of 2,504 operations. Acta Orthop Scand Suppl. 1972;142:1-95. doi:10.3109/ort.1972.43.suppl-142.01
Clinical Efficacy of Mechanical Traction as Physical Therapy for Lumbar Disc Herniation: A Meta-Analysis - PubMed. Accessed January 31, 2024. https://pubmed.ncbi.nlm.nih.gov/35774300/
Masaryk TJ, Ross JS, Modic MT, Boumphrey F, Bohlman H, Wilber G. High-resolution MR imaging of sequestered lumbar intervertebral disks. AJR Am J Roentgenol. 1988;150(5):1155-1162. doi:10.2214/ajr.150.5.1155
MR image-based grading of lumbar nerve root compromise due to disk herniation: reliability study with surgical correlation - PubMed. Accessed January 31, 2024. https://pubmed.ncbi.nlm.nih.gov/14699183/
Jensen MC, Brant-Zawadzki MN, Obuchowski N, Modic MT, Malkasian D, Ross JS. Magnetic resonance imaging of the lumbar spine in people without back pain. N Engl J Med. 1994;331(2):69-73. doi:10.1056/NEJM199407143310201
Forristall RM, Marsh HO, Pay NT. Magnetic resonance imaging and contrast CT of the lumbar spine. Comparison of diagnostic methods and correlation with surgical findings. Spine (Phila Pa 1976). 1988;13(9):1049-1054. doi:10.1097/00007632-198809000-00013
Herzog RJ. The radiologic assessment for a lumbar disc herniation. Spine (Phila Pa 1976). 1996;21(24 Suppl):19S-38S. doi:10.1097/00007632-199612151-00004
Reulen HJ, Pfaundler S, Ebeling U. The lateral microsurgical approach to the “extracanalicular” lumbar disc herniation. I: A technical note. Acta Neurochir (Wien). 1987;84(1-2):64-67. doi:10.1007/BF01456353
Leonardi M, Pfirrmann CW, Boos N. Injection studies in spinal disorders. Clin Orthop Relat Res. 2006;443:168-182. doi:10.1097/01.blo.0000200254.42500.58
Weber H. Lumbar disc herniation. A controlled, prospective study with ten years of observation. Spine (Phila Pa 1976). 1983;8(2):131-140.
Weinstein JN, Tosteson TD, Lurie JD, et al. Surgical vs nonoperative treatment for lumbar disk herniation: the Spine Patient Outcomes Research Trial (SPORT): a randomized trial. JAMA. 2006;296(20):2441-2450. doi:10.1001/jama.296.20.2441
Buttermann GR. Treatment of lumbar disc herniation: epidural steroid injection compared with discectomy. A prospective, randomized study. J Bone Joint Surg Am. 2004;86(4):670-679.
Atlas SJ, Deyo RA, Keller RB, et al. The Maine Lumbar Spine Study, Part II. 1-year outcomes of surgical and nonsurgical management of sciatica. Spine (Phila Pa 1976). 1996;21(15):1777-1786. doi:10.1097/00007632-199608010-00011
Battié MC, Videman T. Lumbar disc degeneration: epidemiology and genetics. J Bone Joint Surg Am. 2006;88 Suppl 2:3-9. doi:10.2106/JBJS.E.01313
Simmons JW, Nordby EJ, Hadjipavlou AG. Chemonucleolysis: the state of the art. Eur Spine J. 2001;10(3):192-202. doi:10.1007/s005860000234
Gibson JN, Grant IC, Waddell G. The Cochrane review of surgery for lumbar disc prolapse and degenerative lumbar spondylosis. Spine (Phila Pa 1976). 1999;24(17):1820-1832. doi:10.1097/00007632-199909010-00012
Kambin P, Zhou L. History and current status of percutaneous arthroscopic disc surgery. Spine (Phila Pa 1976). 1996;21(24 Suppl):57S-61S. doi:10.1097/00007632-199612151-00006
McCulloch JA. Focus issue on lumbar disc herniation: macro- and microdiscectomy. Spine (Phila Pa 1976). 1996;21(24 Suppl):45S-56S. doi:10.1097/00007632-199612151-00005
Thomé C, Barth M, Scharf J, Schmiedek P. Outcome after lumbar sequestrectomy compared with microdiscectomy: a prospective randomized study. J Neurosurg Spine. 2005;2(3):271-278. doi:10.3171/spi.2005.2.3.0271
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Copyright (c) 2024 Kaja Surowiecka, Michał Urbaś, Dawid Kościołek, Aleksandra Kościołek, Jakub Misiak, Martyna Kępczyk, Miłosz Ojdana, Konrad Szalbot, Konrad Czchowski, Alicja Chrościcka
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