Management of Problems of the Lumbosacral Spine

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Abstract
Backache is a common cause of disability, and it is usually associated with structural weakness in the lumbosacral region and with faulty use of the back. Backache is often persistent or recurrent. It is an indication for careful diagnostic history, physical examination, and adequate roentgenograms. Obesity and poor posture may be contributing causes. Other causes of backache should be considered in differential diagnosis. Backache of mechanical origin can be relieved in the vast majority of cases by suitable protective measures, by correction of obesity or faulty posture, by appropriate trunk-muscle exercises, and by training in good posture. Backache unrelieved by these treatments, especially if there is a severe structural defect, for example, spondylolysis, may be relieved by spine fusion. Sciatica is also a common cause of disability. Severe persistent sciatica is commonly due to protrusion or extrusion of the nucleus pulposus with pressure against the adjacent nerve root, and it may be associated with neurological signs of nerve-root pressure. Tumor of the cauda equina is considered in differential diagnosis. Partial or temporary relief may be obtained by bed rest for two or three weeks if sciatica is due to mild nerve-root pressure. Severe or persistent sciatica due to extrusion of a nucleus pulposus is best relieved by careful surgical removal of the material causing the pressure. The best permanent results are obtained by removal of the entire nucleus pulposus. Spine fusion at the same time will relieve the backache that usually precedes and accompanies disc rupture and will correct structural weakness in the lumbosacral region. Careful evaluation of the patient, meticulous surgical technique, adequate postoperative care, and an appropriate convalescent regimen are essential for a high percentage of good or excellent results.

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