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Low back pain is a symptom that affects 80% of the general United States population at some point in life with sufficient severity to cause absence from work. It is the second most common reason for visits to primary care doctors, and is estimated to cost the American economy $75 billion every year.
Low back pain may be experienced in several different ways:
- Localized. In localized pain the patient will feel soreness or discomfort when the doctor palpates, or presses on, a specific surface area of the lower back.
- Diffuse. Diffuse pain is spread over a larger area and comes from deep tissue layers.
- Radicular. The pain is caused by irritation of a nerve root. Sciatica is an example of radicular pain.
- Referred. The pain is perceived in the lower back but is caused by inflammation elsewhere—often in the kidneys or lower abdomen.
Epidural strictly means ‘on the dura’. In anatomical usage it means outside or around the dura mater, which is the outermost of the membranes (meninges) that ensheath the brain and spinal cord. In the vertebral canal there is a narrow space between the dura mater and the lining (periosteum) of the bones; local anaesthetic injected into this space abolishes sensation from those parts of the body served by nerves that enter the spinal cord below the level of injection. In the skull, the dura has two layers, and the outermost is itself the lining of the bone and firmly adherent to it. Head injury that involves fracture in the region of the temple where there are particularly vulnerable blood vessels, can lead to an epidural (‘extradural’) collection of blood, stripping the dura from the bone, and requiring drainage by trephining to alleviate compression of the brain.
Dorsal Column Stimulators
A column situated dorsally in each lateral half of the spinal cord which receives the terminals of some afferent fibers from the dorsal roots of the spinal nerves.
Degenerative Disc Disease Treatment
Nearly everyone shows some signs of wear and tear on the spinal discs as they age. Not everyone, however, will have symptoms described as degenerative disc disease. Not actually a disease, degenerative disc disease refers to a condition in which pain is caused from a damaged disc. A wide range of symptoms and severity is associated with this condition.
A diagnosis is based on a medical history and a physical examination, as well as the symptoms and the circumstances where the pain started. Magnetic resonance imaging (MRI scan) can show damage to discs, but it alone cannot confirm degenerative disc disease.
- Artificial disc replacement
- Surgical intervention
- Non-operative treatment of symptoms