If you’re experiencing lower back pain, rest assured it’s a very common problem. In fact, it’s estimated that 60-90% of individuals will experience some form of back pain in their lifetime.

Many people with lower back pain also experience pain that radiates, or travels, into one leg. This is called sciatica, a term that refers to pain occurring along the distribution of the sciatic nerve. People often describe a sharp, electric or burning sensation that travels down their leg into their foot that may or may not be accompanied by weakness. Generally, this type of leg pain is caused by either lumbar spinal stenosis or lumbar disk herniation, a result of compression, or narrowing, of the spaces surrounding the spinal nerve roots.

Lumbar spinal stenosis is a condition resulting from narrowing of the spinal canal which, in general, is related to aging. As we age, our spinal canal’s bony and soft tissue elements begin to degenerate and the canal may become compressed. This is called stenosis, and can result in pinching and/or irritation of the spinal nerve roots.

Individuals with spinal stenosis often report back pain, in addition to pain radiating into both legs. This is usually exacerbated by standing or walking, while sitting, lying down or sometimes bending forward often relieves the pain. Lumbar stenosis can also produce leg numbness, as well as a feeling of generalized leg weakness, which unfortunately can make the patient more susceptible to falls.

Diagnosing lumbar stenosis involves a careful physical examination and thorough patient history. Normally, an MRI or CAT scan is utilized to confirm the diagnosis. Treatment of lumbar spinal stenosis begins with a conservative approach, as do most problems involving the spine. In the beginning of care, a patient is usually put into physical therapy though non-steroidal anti-inflammatory medications can be added to the regimen as needed. In cases where first-line therapy fails or is insufficient, long-acting cortisone injections into the spine can be considered. An outpatient procedure, these injections have resulted in complete resolution of pain in many patients.

In cases where conservative measures aren’t met with pain reduction or symptoms progress, surgery is then considered. The surgical procedure for lumbar spinal stenosis is called decompressive laminectomy. With laminectomy, the lamina, or bony roof of the spinal canal, is removed allowing for immediate relief of pressure on the spinal nerve roots. After surgery, patients are admitted to the hospital and stay from one to three days in most cases. Prior to discharge, patients are walking and caring for themselves. The risks of this type of surgery are very low and offer significant benefit to those suffering from the symptoms of spinal stenosis.

The intervertebral disk, or simply disk, is the shock-absorbing structure located between the bones of the spinal column. The disk is comprised of two components—the annulus, or outer portion, and the nucleus pulposus, or central portion. With aging, the outer portion of the disk degenerates, which can lead to the central portion pushing out or extruding. This is called a herniated or extruded disk, a disk rupture or slipped disk and can result in compression of the spinal nerve roots (cause of sciatica). If the nerve compression is severe enough, this can cause extreme pain, weakness, numbness, reflex changes or impairment of bowel or bladder function. Most patients recover with medication, bed rest, physical therapy and time though for some, surgery is required.

When a patient is considered for surgery, usually an MRI is obtained to confirm the diagnosis. The MRI also serves as a guide for the surgeon as to where the problem is in relation to the spinal column and spinal nerve roots. The goal of surgery is to relieve the pressure from the herniated disk on the nerve roots which can lead to dramatic improvement in pain and other symptoms.

This surgical procedure is termed ‘microdiskectomy’ or ‘diskectomy’. Patients undergoing this procedure are typically hospitalized for one to two days after the operation, and can usually perform routine activities once discharged. In order to reduce the risk of recurrent disk herniation, restrictions regarding heavy lifting and/or strenuous physical activity are given to the patient as part of the discharge plan. The discharge plan may also include physical therapy to improve strength and flexibility. Overall, microdiskectomy is low-risk procedure with a complication of rate of less than 1%.

Lumbar fusion is a surgical procedure designed to stabilize the spine by initiating new bone growth and preventing movement between adjacent bones. Patients who undergo a fusion procedure usually have either a bone fracture or a condition known as spondylolisthesis. Most fractures are traumatic, but in older patients, spine fractures can result from osteoporosis. Spondylolisthesis is a clinical term that describes a slippage or displacement of one bone (vertebrae) in relation to another. This often results in back and leg pain, a common reason patients seek consultation with a spine specialist such as a neurosurgeon.

The fusion procedure often involves placement of ‘hardware’ such as screws and rods, which are devices designed to immediately stabilize the spine and thereby augment the fusion process. The choice of hardware is dependent on what the patient needs for optimal recovery as determined by the surgeon.

Patients undergoing a fusion procedure are often hospitalized for three to five days. Depending on the extent of the fusion, many patients will be required to wear a specially fabricated brace for support. Spine x-rays are taken at 6-12 week intervals to follow the process of fusion.