Low back and back pain is one of the most common problems we encounter throughout our lives after colds. Low back pain is a symptom, not a disease, and is a precursor to many, sometimes unrelated, ailments related to the back. Lumbago, sciatica (low back pain represents a different disease group and is often misused) as it is known by the people, is more common in the middle age group, and it is considered as acute low back pain that lasts up to 3 months. The severity of the pain can range from pain that only occurs with certain movements that do not affect daily life to a level that leaves the person motionless. Weight, physical activity, occupation, smoking habit, sitting position, sleeping position at night and the structure of the bed, and even the psychological state of the person are effective in the formation of pain. In addition, kidney diseases, ovarian inflammation in women, pelvic inflammatory diseases and some diseases related to intra-abdominal organs can cause or be confused with low back pain, although they are not related to the waist.
Our spine system is a very important structure that carries 2/3 of the entire weight of our body from the head to the abdominal organs and also helps us to walk by ensuring that we stand upright with the muscle-connective tissue here. It consists of a total of 30 vertebral bones, 24 of which are movable, like rosary beads stacked on top of each other, a long tunnel in the middle of which the spinal cord passes, which regulates the functioning of all organs and ensures our movement, and discs that act as a suspension between each vertebra. In addition, one tree branch-like nerve roots emerge simultaneously from each spinal bone to the right and left. These structures are surrounded by the spine and the surrounding solid muscle and connective tissues.
All these structures are interrelated and perform their functions in coordination. While doing this, they try to keep the person standing and upright against an extraordinary load, such as the resistance shown by the throat bridge and weight-bearing ropes. In this respect, the waist and back muscles and connective tissues are under constant stress and load. It is quite easy for this structure, which resists such a heavy weight, to be injured or to have some discomfort. Low back and back pains occur as a result of mechanical stress of the system, additional load, staying in an inappropriate position for a long time. In other words, 80% of all low back and back pains are Mechanical Low Back and Back Pains that occur without an organic disorder in bone, muscle and connective tissues. The most common form can be in the form of lifting, dragging or pushing a heavy object, or it can be caused by bending down suddenly. Such pains are relieved with rest painkillers and heat application within 48-72 hours, and completely disappear within 1-2 weeks. If prolonged, other diseases should be considered.
The structures called gelatinous disc, which is located between 24 mobile vertebrae in the body and acts as a suspension, can distort their normal structures due to physical trauma, reverse movement or feeding problems, and can change shape and place, compress the nerves or spinal cord in the immediate vicinity. As a result, various levels of pain, numbness, loss of strength, and even uncontrolled urination and bowel movements occur in the lower back, feet and toes. Pain, increasing with movement, starting from the waist and extending to the toes or heel in a knife-like manner in the hip, may cause numbness and loss of strength with or without it. Sometimes, people say that their complaints increase especially with walking and they decrease with rest. The presence of these complaints and the positivity of the examination findings in the barber bring us closer to the diagnosis of herniated disc.
In the diagnosis of patients with low back and back pain, the history of the disease, neurologic examination and radiological examinations make the diagnosis with an accuracy of 98%. Although radiological examinations are highly instructive, they are not meaningful on their own. In the initial phase, direct x-ray, blood tests, then computerized tomography, EMG (Electromyography) and magnetic resonance imaging (MRI) examinations may be required if surgery is required or still not diagnosed. None of these alone is sufficient.
TREATMENT METHODS
Low back disorders are progressive disorders such as calcification, herniated disc, slipped back and rheumatic diseases. The aim of the treatment is to prevent the progression of the disease, to prevent neurological damage or to restore normal physical activity by reversing it. For this purpose: the treatment methods applied can be summarized as follows
A) In the Acute Period
1) Conservative treatment
I. Medication, painkillers and muscle relaxants
II. Absolute bed rest (7-10 days without standing up)
III. Regional Heat application
IV. Traction and corset? (There are discussions about the benefit of traction. I. These are treatments administered under the supervision of specialists. Rather than treating the disease, they help reduce pain and edema around the nerves and relax the muscles.
II. Spa Treatment: With the permission of internal medicine and cardiology doctors, it is beneficial for at least 3 weeks in line with the recommendations of the physiotherapist and with the selection of the appropriate type of spa. But it does not destroy the existing pathology, it is aimed at pain.
2) Exercise Therapy and Low Back School: With the advice and evaluation of the Physiotherapist before or after the surgery, a personalized exercise program to strengthen the waist-back muscles is a truly preventive treatment approach in the long run. When this treatment is applied patiently and regularly, it prevents the formation of herniated disc and osteoarthritis and slows the worsening of existing ones.
2) Surgical treatment: Although there are many different methods for lumbar hernia (Laser therapy, Chemonucleosis, macrodiscectomy, etc.), microdiscectomy is the method preferred by the whole world today. Patients who return to their normal life after a one-day hospitalization period and a 2-3 week rest period after surgery achieve full recovery, provided that they do not repeat their previous mistakes in their lives.
Microdiscectomy is a method used successfully in interventions up to 3 distances. Surgical treatment should be applied in cases where other treatment methods fail in low back diseases, the desired result cannot be achieved or neurological damage is detected. The general principle in surgical treatment is to prefer the method that causes the least damage to the patient and his/her tissues and puts them at the least risk, with the least risk of complications. In the meantime, the previous systemic diseases, age and patient-physician compatibility are very important. If necessary, the patient is evaluated by the doctors of related branches such as internal medicine, cardiology and anesthesia, and the most appropriate treatment approach is selected. Microdiscectomy has been increasingly preferred as a surgical method all over the world and in our country for the last 20 years. In this procedure, surgeries can be performed with high-magnification microscopes, and pathologies that cannot be seen with the naked eye can be detected and tissues can be seen in great detail. In our hospital, we go one step further and if there is no limiting factor, Interlaminar Microdiscectomy is performed with Epidural-spinal Anesthesia. In this method, unlike the classical microdiscectomy, operations are performed through a 2 cm surgical incision under the microscope, only between soft tissues and without bone removal. In this way, an extremely comfortable and safe operation is performed, and a rapid return is provided in the postoperative period. The patients stand up within 6 hours and the hospital stay is limited to 1 day. After leaving the hospital, it is possible to return to daily work and social life after 10 days of bed and 10 days of home rest.
Microsurgery with relaxing Epidural-spinal Anesthesia can be applied in calcifications in the waist, if other treatments are insufficient, to reduce the nerve compressions. With this procedure, the excess bone tissues around the nerves that prevent their movement and functioning are removed by shaving and the nerve is relieved. Operations with this method give more satisfactory results than expected.
Mild lumbar dislocations can also be successfully treated with Epidural-spinal Anesthesia, Interlaminar Microdiscectomy and Chace application to the disc distance. In more advanced lumbar shifts, necessary nerve relaxation and spine stabilization procedures can be applied to ensure a short-term recovery.
All procedures have a success rate of 90-95%, and very good results are obtained if the recommendations are followed in the postoperative period. In the long term, success increases in proportion to the person’s genetic structure, weight, occupation, smoking habit and compliance with the exercise program. The implementation of a program under the control of Physical Therapy and Rehabilitation, which starts after the third week, will be beneficial for the future.
In all treatments, the harmony between the patient and the physician should be very good. Appropriate height-weight ratio, good exercise planning to strengthen the waist muscles, avoidance of adverse and heavy movements, a life away from smoking, can be a guarantee of a quality and pain-free life in the long run
