Spinal conditions, especially in the lower back or lumbar spine are extremely common. Most people, at some point in their lives have had an episode of severe back pain. These episodes of back pain can be associated with sciatica or the medical term, radiculopathy. With a radicu­lopathy, a specific nerve leaving from the spine becomes inflamed and pain­ful. The pain from a radiculopathy typically originates from a general area in the lower back and radiates down the thigh and leg. This description of the pain is charac­teristic of a lumbar spine problem.

Several condi­tions of lumbar spine can lead to sciatica or radiculopathy. Two of the most common include a lum­bar disc herniation and lumbar spinal stenosis.

Lumbar Disc Herniation

The spinal column consists of boney elements and intervertebral discs. The front part of the spine is the vertebral body. Each vertebral body is separated by the interverte­bral disc. Because we are the only creatures on earth that spend most of the time upright, humans are particularly susceptible to degen­erative changes in the spine as we age. The intervertebral discs can be prone to injury and herniation. With disc injury and herniation, the inner part of the disc can come in contact with and irritate the nerve roots. The nerve roots leav­ing the spine are susceptible to this irritation. This causes the sciatica or radiculopathy.

Often this can be managed non-operatively with pain medicine, anti-inflammatory medication, and muscle relaxants. Severe or disabling leg pain or weakness can be treated successfully with surgery. Surgery for disc herniations is done today using a minimally invasive technique through an incision approxi­mately an inch long. Patients are typically discharged home the same day.

Lumbar Spinal Stenosis

Lumbar disc herniation, typically occur in people of working age, 20-50. As we age the spine can tend to become arthritic, stiffer, and generally not susceptible to disc herniations. With aging, the interver­tebral disc tends to degenerate and col­lapse. At the same time the lumbar facets joints can become arthritic and enlarge. Also occurring is the thickening of the yellow ligament or the ligamentum fla­vum. The triple hit can cause encroach­ment on the spinal canal and the symp­toms of the lumbar spinal stenosis.

Patients with lumbar spinal stenosis are typically 60+ years old. They describe a characteristic his­tory of leg pain, numbness, burn­ing or heaviness that develops when they ambulate. This discomfort can significantly limit the distance they can walk. Patients typically find themselves leaning forward or sit­ting down to relieve this leg pain.

Today there are many treat­ments available for lumbar spinal stenosis. As with most spinal conditions, treatment at first is non-operative involving physical therapy, and medication. Treatment can also include epidural injec­tions. These epidural injections are tailored for each individual patient’s condition. The injections aid in confirming the diagnosis and decreasing the inflammatory com­ponent and pain associated with lumbar spinal stenosis.

After some time, epidurals typically run their course and give limited utility. At this point surgery may be an option. Surgery for lum­bar spinal stenosis can lead to a predictable improvement in thigh and leg complaints.

Fortunately, most spine problems do not require surgery and can be managed with medications and physi­cal therapy. Ocean Orthopedic Associates are experts in man­aging acute attacks of this type of pain. We have a state of the art facility that allows us to offer and coordinate our patient care with our own physical therapy department. We can aid in expediting your evaluation with digital x-rays and our own open MRI. This allows us to establish a diagnosis and begin treatment in an expeditious man­ner, providing better patient care.