Back pain is the second most common complaint after common cold. 7 out of 10 people
suffer from back pain during some point of their life. It is also responsible for maximum
loss of man hours in the community.
Sciatica means pain traveling along Sciatic nerve, which is the main nerve of the leg. It
usually happens due to compression of the sciatic nerve mainly in the spine.
Some of the common causes of back pain include,
Most of patients visiting clinics are young and have no associated complaints to direct the
spine surgeon to the cause of pain. Some of them have this pain for years together due to
negligent habits and bad posture. Postural causes can be treated completely with back
exercises, proper posture and general conditioning exercises over a period of few months.
Second subset of young patients may have associated morning stiffness with symptoms
of more than few months to years. On detailed examination they show restricted spine
movements and chest expansion suggestive of Ankylosing spondylitis.
Most of these old patients have Spinal Osteoporosis. Spinal Osteoporosis is a disease
characterized by weakness of the vertebrae due to gradual loss of bone mass. This is
common in females after menopause due to withdrawal of hormones required for calcium
deposition in bones. Male Osteoporosis occurs usually 10 years later as compared to
females. Treatment of osteoporosis include certain medicines and injections but if
diagnosed in time it can prevent serious complications of spinal fractures and paralysis.
Facet joint arthritis and discogenic causes of back pain though are also not uncommon.
Instability and Infections can be easily diagnosed and treated with medicines and
sometimes surgery.
Sciatica is commonly due to compression of nerve in spine due to a slipped disc
or narrowing of spinal canal due to old age. It may be associated with back pain when
associated with spinal instability (Spondylolisthesis).
Most of the time sciatica due to slipped disc responds to medicines and physiotherapy.
With proper postural care and back exercises it can be treated with complete relief.
Though some of these patients may not respond to conservative treatment and may be
offered surgery for faster relief, studies conducted in these patients have shown equal
results over a period of 2-4 years. Surgery in disc prolapse in mainly elective unless
patient develops urinary weakness which needs urgent surgery to release pressure on
nerves.
Narrowing of spinal canal due to old age typically causes increase in severity of leg pain
while walking. Most of these patients have long history of such pain before they seek
doctor's opinion. If they dont get desired relief in their symptoms with medicines in 1-2
months time then surgery becomes necessary.
When sciatica is associated with reasonably severe back pain also then just relieving
compression of nerves is not enough as sometimes this leads to increase in back pain in
these patients. In these circumstances it is wiser to look for instability or other cause for
back pain in the dynamic x rays before surgery is done. If instability is found or when in
doubt it is better to fix the spinal segment with screws and fuse it to prevent worsening of
the situation.
