Most people have experienced or will experience back pain at some point in their lives, which is generally in the lumbar or lower back area. However, when back pain becomes chronic (anything beyond 3 to 4 weeks) further investigations are required. Many patients are advised prolonged bed rest which only makes thing worse and results in muscle wasting, further back muscle weakness and aggravates osteoporosis resulting in more back pain. 


It is most important that these patients are examined by an experienced spine Surgeon, who may be of orthopedic or neurosurgical background. The spine surgeon after careful history taking and examination will have some idea of the pain source. He will then ask for relevant investigations like X-ray, CT scan, MRI scan, Dexa scan, discography or trial of facet joint or sacro-iliac joint block or vertebral biopsy. If spinal infection like TB or vertebral body tumor is suspected then the patient is investigated along those lines.


Possible Causes of chronic lumbar back pain

  1. Back pain of facet (osteoarthritis) and sacro-iliac joint origin.

  2. Back pain from lumbar disc degeneration (degenerative disc disease)

  3. Spinal Stenosis (lumbar canal stenosis)

  4. Scoliosis/Kyphosis 

  5. Spondylosisthesis / spondylosis

  6. Vertebral compression fracture 

  7. Osteoporosis of the spine 


Chronic back pain and its treatment is discussed further depending on the origin of pain i.e. facet or sacro-iliac joint, disc, muscle, vertebral body or the nerves arising from the spinal cord.

Once investigations are complete the spine surgeon will decide the next line of treatment. This may be:

  1. Exercise and physiotherapy,

  2. Facet Block & Radiofrequency (RF) Rhizotomy

  3. Artificial Lumbar Disc Replacement

  4. Spinal Fusion

  5. Vertebroplasty or kyphoplasty

  6. Spinal cord stimulator