Mechanical Back Pain (lumbar spine)

Question 1

what is thought of as mechanical back pain

Answer 1

recurrent relapsing and remitting back pain with no neurological symptoms

Question 2

when is the pain worse and when is it relieved

Answer 2

worse on movement and better on rest

Question 3

what age are patients when they typically experience this pain

Answer 3

between 20 and 60

Question 4

what are common causes

Answer 4

obesity, poor posture, poor lifting technique, lack of physical activity, depression, degenerative disc collapse, facet joint OA and spondylosis

Question 5

what is spondylosis

Answer 5

intervertebral discs lose water content with age

Question 6

what does spondylosis result in

Answer 6

less cushioning and increased pressure on facet joints leading to secondary OA

Question 7

what is treatment

Answer 7

analgesia and physio

reassurance they are okay and encouraged to continue as normal

Question 8

why is bed rest not recommended

Answer 8

leads to stiffness and spasm which exacerbated disability

Question 9

when would spinal stabilisation surgery be considered

Answer 9

• if a single level (two adjacent vertebrae L2/3) is affected by OA or instability
• the patient has not improved with physio and conservative measures
• no adverse secondary gain or behavioural issues which would negatively impact surgery outcome

Question 10

what is instability

Answer 10

excessive motion caused by degenerative disc

Question 11

how is instability typically diagnosed

Answer 11

MRI

Question 12

why do many patients not receive surgery

Answer 12

usually multi-level disc involvement

Question 13

what is a negative of spinal stabilisation surgery

Answer 13

symptoms tend to recur and there is no benefit after around 5 years