Pathologies for L1-L5 (Lumbar spine)
Lower Back Pain
One of the most common reasons for a doctor visit is back pain. Back pain is also the leading cause of disability in the UK and it is the main reason for missed worked days in the USA. It is estimated that about fifty percent of adults experience back pain each year.
Lower back pain (LBP) can be especially disabling as it affects the lower part of the spine, and therefore the balance and stability of the upper body as a result. LBP affects the L1-L5 vertebrae of the spine, which correspond to the lumbar spine, or lower back as it is commonly referred to.
Oftentimes the treatment for problems in the lower back is more straightforward but may depend on the condition that affects the spine, as well as its severity. Some of the most common causes for lower back pain include pinched nerves, disc problems, joint problems, spinal deformities as well as muscular issues.
Additional resources on generalised lower back pain:
Additionally, you can read more about each pathology of the lumbar spine below.
Sciatica is a spinal issue that occurs when the sciatic nerve becomes pinched. The nerve starts in the lower back (lumbar spine) and branches down the back of each leg.
People with sciatica may experience pain in the lower back as the first symptom. Sciatic nerve pain may be constant, or it may come and go. Most often it occurs along only one of the sciatic branches, but some people may experience bilateral sciatica, where both branches of the nerve are pinched.
People who suffer from this issue tend to initially develop sciatica when the sciatic nerve becomes irritated due to spinal compression. As such, by treating the root cause – spinal compression – sciatic nerve pain shall go away as a result.
A herniated disc, also called a slipped disc, occurs when the one of the discs of the spinal column is injured and the inner portion of the disc protrudes through the outer ring of the disc.
If any one of these discs slips out of place, the bones in the spinal canal collide with each other and put pressure on a spinal nerve, or multiple spinal nerves, which can trigger pain, stiffness and other symptoms.
Spinal stenosis is the narrowing of the spinal canal, through which the extension of the central nervous system (spinal cord and spinal nerves) passes. It can affect any of the three major sections of the spine, but it most commonly occurs in the lower back.
The primary cause of spinal stenosis can be attributed to wear and tear of the spinal column, and its adjacent structures.
With time, the composition of the spine erodes due to the shock it has to absorb from everyday movement and can lead to changes in the shape of the spine. This can also lead to obstruction or narrowing of the spinal canal.
Cauda Equina Syndrome occurs when the nerve roots of the cauda equina are compressed. Cauda equina (Latin for a horse’s tail) is the lowermost area of the spinal cord, shaped like the tail of a horse, from where various nerve roots branch out.
The spinal cord ends at the upper portion of the lumbar spine. Due to pressure on the lower nerve roots, motor and sensory functions may be disrupted as these nerve roots supply the lower extremities and the bladder.
Piriformis syndrome is a type of neuromuscular disorder that is not very common. It happens when the sciatic nerve gets compressed by the piriformis muscle.
The piriformis muscle is a ribbon-like muscle present in the saddle area near the upper part of the hip joint. This muscle’s function is to stabilize the hip joint and to make possible the lifting and rotation of the thigh away from the torso. Thus, this muscle is very important for the movements of the lower part of the body.
The sciatic nerve goes through this muscle. It is quite thick and takes a very long path, starting from the lower back, going down the back of the leg and divides into two different branches. Spasms of the piriform muscle may take place, causing spinal compression and places pressure on the sciatic nerve, and in turn leading to piriformis syndrome.
This includes postural syndrome (which can be defined as a condition in which repetitive poor posture or bad positioning of one’s body, that is sustained for prolonged periods of time, results in dysfunction or pain), Flat Back Syndrome (a disorder in which the lower part of the vertebral column loses some of its normal anatomical curve, causing a front to back imbalance in the vertebral column), Scoliosis (an exaggerated sideways curvature of the spine) as well as general poor posture practices, such as slouching, hunching over a desk or smartphone, or sleeping in an awkward position for long periods of time.
Spondylolisthesis is a pathological condition in which a vertebra slips out of its normal anatomical place on to the adjacent vertebra present lower to it.
When one of the vertebrae (bones that make up the human spine) slips out of place, it can lead to a series of symptoms and possible complications, such as spinal cord and nerve compression.
In turn this can lead to pain, stiffness, loss of mobility, and other problems.
Degenerative changes happen mostly with age and have no specific reason. The condition causes the spine to change shape and lose the typical structure or function.
Degeneration is caused chiefly by repetitive strains, sprains, and overuse of the back that leads to a gradual change or degeneration to the spinal discs.
After the age of 40, mostly everyone experiences some degenerative change. Spondylosis, Osteoarthritis, Bone Spurs, Degenerative Disc Disease and Lumbar Joint Dysfunction Syndrome fall under this category.
Spondylosis is characterised by degeneration of the spine caused by the wear and tear process that occurs with aging. It is not a standalone condition in itself, but rather it encompasses a range of issues associated with an aging spine, such as degeneration of the facet joints, degeneration of the discs between the vertebrae, as well as other spinal issues that arise due to aging.
The word ‘arthritis’ means the inflammation of joints. Spinal osteoarthritis refers to the inflammation of the facet joints of the vertebral column. Osteoarthritis of the vertebral column is a common cause of lumbar back pain nowadays specifically in the people of advancing age.
A bone spur is an overgrowth of bone that can occur along the edges of a bone. It is also called an osteophyte.
Degenerative Disc Disease, or DDD for short, is a medical condition where the wearing out of the spinal discs leads to back pain. The wear and tear process is often attributed to aging, but there are other causes for it as well.
Facet joints are a type of joints that join the vertebrae and allow for specific bending movements. In time, they can become worn down and be subject to facet joint disease.
Problems in the lower back can cause symptoms that extend to other parts of the body, such as the legs. One of the most common factors for this type of leg pain is sciatica. As the sciatic nerve runs along the lumbar spine and branches down the back of each leg, when it becomes pinched, it can cause the pain to extend from the lower back into one or both legs.
Additionally, problems in the lower back can also be linked to short leg syndrome.
Lumbar lordosis (hyperlordosis) is a postural disorder in which the natural curvature of the lumbar spine is slightly or markedly enhanced. It commonly happens when the spinal column has to bear extreme stress or extra weight repeatedly and it becomes excessively curved. The exaggerated curvature that results can can lead to issues such as lower back pain, muscle pain and spasms.