The lumbar spine is a complex system that serves three functions:
1. Supports the body
2. Allows for movement
3. Protects the lumbar and sacral nerves
There are 4 anatomical structures in the lumbar spine that are most important in the origin of back, pelvic, and leg pain:
1. The lumbar bones, called vertebrae
2. The lumbar discs
3. The lumbar facet joints
4. The lumbar and sacral nerve roots
The support function is made possible by 5 lumbar vertebrae, called L1, L2, L3, L4, and L5 These bony structures support the body. They also protect the nerves.
The movement function is made possible by the lumbar discs and facet joints. In the front of the spinal column, we have 5 oval pieces of soft tissue sandwiched in between the vertebrae, called discs Therefore, each two vertebrae are connected by a three-joint complex, one disc in the front and two facet joints in the back.
The discs and facet joints are the “moving parts” of the lumbar spine. Naturally, moving parts are prone to wear and tear, or degeneration. Wear and tear of the discs is called disc degeneration, or internal disc disruption. Wear and tear of the facet joints is most frequently called osteoarthritis, or just arthritis.
Disc degeneration and facet joint arthritis are not necessarily painful, but in people with back pain, it is highly likely that their pain stems from these two structures. About 40% of back pain stems from the lumbar discs, and about 5-15% of back pain stems from the facet joints.
Pain from discs and facet joints is felt most of the time in the back, but it can also be felt in the pelvis, lower abdomen, and thigh. Here are some diagrams illustrating how disc or facet joint pain spreads.
Another consequence of disc and facet joint wear and tear is stenosis, or narrowing of the canals housing the lumbar or sacral nerves. Central canal stenosis usually affects several nerves, and can result in leg weakness on both sides, loss of sensation, and even loss of bowel and bladder control. Lateral stenosis is narrowing of the canals on both sides of the discs, and it affects individual nerve roots. This usually results in sharp, shooting pain down one leg, commonly referred to as “sciatica”.
The most important step in addressing back, pelvis, and leg pain is a correct diagnosis. Pain from facet joints, discs and individual nerves can be diagnosed with very precise techniques.
Once the correct diagnosis is made, there are several options of treatment, some non-surgical, some surgical. A correct diagnosis will make the treatment more likely to be successful.
Please refer to our website for more details regarding the diagnostic and treatment techniques for lumbar and pelvic pain sources.
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