Axial back pain
Axial back pain is extremely common in the community. Whilst extremely common, it is undeniable that back pain can be the most intrusive of afflictions. Back pain is the second most common to seek medical attention and in Australia the medical condition which causes the largest loss of productivity.
Traditionally this disabling condition has been managed non-operatively, with patients prescribed pain-killers, activity modification, various therapy regimes, chiropractic manipulation amongst other regimes. With the advent of modern technologies that aid in the diagnosis and treatment of discogenic back pain, the pendulum is swaying towards operative care in recalcitrant cases, where patients have exhausted non operative management. Whilst there is increasing evidence to support operative treatment, I adopt a pragmatic approach that operative treatment, rather than a cure is a “piece of the therapeutic diaspora’ that when amalgamated allows a patient to cope with the tyranny of axial back pain.
Axial back pain is by definition a mechanical symptom associated with the degenerative cascade of the vertebral column.
Patients typically present with lower back pain, which may radiate. This pain may be provoked by bending forward, lifting, coughing and respite may be gained from rest or hydrotheraphy.
Xrays usually reveal degenerative changes including loss of disc height and osteophytes (spurs) and sometimes a full length spinal x-ray will be requested to access for overall alignment. MRI scanning will corroborate the diagnosis and provide a guide to treatment. In some instances discography may be utilised.
This includes non-operative measures including: pain-killers, physical therapy and occasionally corticosteroid injections. Operative indications include: intractable pain, protracted symptoms and precipitous decline in function as a consequence of a worsening neurological deficit. There are many surgical options available and it is my practice to tailor a solution to the unique anatomic and material circumstances of an individual patient.
Operative treatment includes: