Low back pain is the most common musculoskeletal disorder and the most common reason for patients to seek medical attention after the common cold. It is the #2 cause of missed work and the #1 cause of disability in patients younger than 45. Four out of five people will experience back pain in their lives. There are many risk factors which include smoking, posture, genetics, body morphometry, and work conditions. Ironically, the severity of the pain is often unrelated to the extent of physical damage. Muscle spasm from a simple back strain can cause excruciating back pain that can make it difficult to walk or even stand, whereas a large herniated disc or completely degenerated disc can be completely painless.

Patients with low back pain are often plagued with frustrations, confusion and distress. Depending on whom they consult (orthopedic, neurosurgeon, traditional medicine practitioners), they may be told different things, ranging from muscle strain, bone degeneration to spinal pain. There are a lot of causes for low back pain but yet culminating to a common outcome such as significant disability, suffering and high medical utilisation.

The causes of low back pain can be very complex, and there are many structures in the low back that can cause pain.

The following are possible sites and mechanisms of low back pain:

  A. Non mechanical back pain. This accounts for 60% of all acute back pain. Medication and increased exercise tolerances form the cornerstone of treatment. Excessive bed rest and avoidance may be counter-productive for the back pain.

Disorders of the muscle, fascia, ligaments, and supporting structures. See Myofascial pain syndrome and Fibromyalgia. These types of pain can be extremely disabling. Significant risk factors include female gender, stress, hormonal disorder, deconditioned muscle.

  B. Mechanical Back pain.The remaining 40% may be treated with interventional pain procedures.

1. Intervertebral Disc
2. Impingement of spinal nerve roots
3. Disorders of alignment of the spine (scoliosis, spondyloslisthesis)
4. Disorders of size/and or shape of the canal (spinal stenosis)
5. Facet Arthropathies/Spondylosis
6. Pathological conditions of the vertebral body

It is important to note that some types of low back pain have no known anatomical cause, but the pain is still real and needs to be treated. However, usually low back pain can be linked to a general cause (such as muscle strain) or a specific and diagnosable condition (such as degenerative disc disease or a lumbar herniated disc).

Types of lower back pain that indicate a surgical emergency

There are a few symptoms that are possible indications of a serious medical condition requiring surgery, and patients with these symptoms should seek medical attention immediately. These symptoms include:

• Sudden bowel and/or bladder incontinence (cauda equina syndrome)
• Progressive weakness in the legs (cauda equina syndrome)
• Severe, continuous abdominal and low back pain (possible abdominal aortic aneurysm)
• People with fever and chills, history of cancer with recent weight loss, or who have just suffered a severe trauma should also seek immediate medical attention.

The treatment options in the recent past are limited to conservative management, consisting of pain medicine, physical therapy and/or surgery. Over the last few years, a number of non-surgical or minimally invasive procedures have been introduced in an effort to manage patients who fail conservative therapy without resorting to major surgery.

The potential for non-surgical pain procedures to reduce pain is of obvious importance to the patient. Of equal importance is the likely contribution of these treatment methods to restore physical and functional status. In addition, these treatment methods also reduce the level of patient’s pain with an one-off treatment that is minimally invasive with little or no surgical risk and “down-time”.

When patient gets the pain in the legs and back, it is because the nerves are inflamed from the disc protrusion and the leakage of disc material. This will cause the surrounding tissue to be inflamed and it will cause scarring as well as the nerve to be stuck down. Epidural adhesiolysis involve freeing the scarred nerve that is stuck down from these surrounding adhesions or scars.

This procedure essentially is like a ballooning of the blocked heart vessels in angioplasty for ischemic heart diseases. Similarly, using a specialized catheter, the procedure involves injection through the spine which can then free up the obstruction and open up the narrowed space leading to a significant reduction in pain experience by the patient.

Patients who may benefit from this procedure would be those suffering from chronic low back pain, spinal stenosis, patients who do not want a surgery, patients with poor surgical risk as well as those who have failed previous back surgeries. Epidural adhesiolysis require only local anesthesia with mild sedation. Hence the risks together with the “down-time” are significantly reduced.