Treatment Options for Low Back Pain

Many individuals will experience low back pain at some point in their lives. Most who

seek treatment will begin with a conservative treatment plan that typically includes rest, ice,

anti-inflammatories (NSAIDs), muscle relaxants, as well as physical therapy or chiropractic care.

If these are not sufficient, it is likely a radiographic image, CT or MRI study will be viewed by a

radiologist to determine if abnormalities in the lumbar spine may be present.

In the case of radiculopathy, image-guided injections or lumbar decompression spine

surgery are viable options to reduce pressure off a nerve and improve feeling in the legs in

these patients. [1] Osteoarthritis is a condition that may result in spinal stenosis. This occurs in

older patients more commonly than younger individuals and can also be treated with lumbar

decompression. [1] Total disc replacement or artificial disc surgery may be an appropriate

procedure for those with degenerative discs that may be causing debilitating symptoms. 1

In case of painful compression fractures refractory to conservative management, a

procedure called vertebroplasty or vertebral augmentation is a safe and effective treatment to

achieve pain relief, reduce disability and improve quality of life. In the case of spinal cancer

surgery will likely be performed with emphasis placed on removing the tumor, controlling or

reducing pain, and fixing or maintaining neurological function and spinal stability. [2]

With the ability and skills to read multiple types of diagnostic images and offer

image-guided treatments for pain relief, radiologists offer a critical service to help patients get

the necessary treatment to improve their quality of life, and in some cases, save a patient’s life.

 

Author 1: Braden Stoeger UWSP Biology Major

Author 2: Kunal Patel, MD

 

References

Ullrich Jr, P.F, MD, Orthopedic Surgeon. (2004, May 10). “When to See a Surgeon for Low Back

Pain.” Retrieved January 21, 2017, from

http://www.spine-health.com/treatment/spine-specialists/when-see-a-surgeon-low-back-pain

Schneider, J. H., MD. (2010, April 1). “Types of Spinal Tumors.” Retrieved January 21, 2017,

from http://www.spine-health.com/conditions/spinal-tumor/types-spinal-tumors


Importance of Imaging in Low Back Pain

Radiologists utilize imaging studies to accurately diagnose a variety of causes of low

back pain. In primary care, the most commonly used imaging modalities are X-ray, MRI, CT, and

nuclear medicine bone scan. Sometimes, more advanced imaging techniques are used in

anticipation for surgery and that includes CT myelography and PET scans.

By having specialized training with these techniques radiologists are able to provide

assistance to surgeons and other medical practitioners. X-rays are helpful for evaluation of

fracture, bony deformity including degenerative changes, sacroiliitis, disk and vertebral body

height, and assessment of bony density and architecture. MRI or CT is recommended in

patients with severe or progressive neurologic deficits or with serious underlying conditions,

such as vertebral infection, cauda equine syndrome, or cancer with spinal cord compression.

MRI does not require radiation exposure and provides better visualization of soft tissue and

spinal canal, and thus preferred over CT. Computed tomography (CT) has superior depiction of

cortical bone than MRI. It may be better in visualizing fractures and detecting facet

degenerative changes. Bone scans are used mainly to detect occult fractures, stress fractures,

infections, or bony metastases and to differentiate them from degenerative changes.

Radiologists can take patient findings and correlate them with the appropriate imaging

studies to provide diagnoses, further diagnostic studies if needed, and possibly a treatment

plan.

Author 1: Braden Stoeger UWSP Biology Major

Author 2: Kunal Patel, MD

References

Harwood MI, Smith BJ. Low back pain: a primary care approach. Clin Fam Pract.

2005;7(2):279–303. doi: 10.1016/j.cfp.2005.02.010.

Chou R, Qaseem A, Snow V, Casey D, Cross JT Jr, Shekelle P, Owens DK, Clinical Efficacy

Assessment Subcommittee of the American College of Physicians., American College of

Physicians., American Pain Society Low Back Pain Guidelines Panel.

Ann Intern Med. 2007 Oct 2; 147(7):478-91.

Jarvik JG, Deyo RA. Ann Intern Med. 2002 Oct 1; 137(7):586-97.