DR JACQUES DE WET OF MARITZBURG ORTHOPAEDIC CENTRE TALKS US THROUGH DIFFERENT TYPES OF LOWER BACKACHE AND HOW TO TACKLE THEM.
It is estimated that 80% of adults will experience lower back pain in their lives, and that one in four people are suffering with lower back pain at any given time. Severe back pain can lead to marked interference with daily activities. A doctor should always be consulted for back pain persisting longer than six weeks or that manifests with nerve symptoms.
Muscular pain accounts for 85% of all cases of backache, and is caused by overuse and repetitive stress of the muscles of the spine. It can also result from stress or from being overweight. Muscular back pain is often found in patients under 45 years old, but may occur at any age. It results with pain over the lower back, often to either side, but that does not spread to the legs. Muscular backache is not a serious condition and the pain typically lasts less than six weeks. It is treated conservatively with activity modification, low-impact exercises, posture improvement, lumbar corset, massage, and physiotherapy.
In patients over 60, backpain is often due to serious and permanent conditions such as degenerative changes or osteoporosis. Degenerative backache is caused by arthritis of the spine, intervertebral disc collapse and frequently disc herniation. This causes longstanding back pain that can become progressive, and can also result in narrowing of the spinal canal and nerve irritation with radiating pain known as sciatica.
Sciatica is often confused with hip pain as it arises in the buttock, but unlike hip pain, sciatica radiates down the thigh into the leg and may frequently cause numbness and weakness of the leg. MRI scanning is required to properly define the extent of arthritis and nerve compression. Conservative measures include analgesia, activity modification, corsets, and physiotherapy. Where these steps fail, your specialist will recommend an epidural injection to decrease the nerve symptoms and pain. However, where the arthritis and nerve pressure are severe, this can only be relieved by surgery. Surgery for degenerative backache generally includes nerve decompression by removal of constrictive bone (laminectomy), disc clearance and fusion of the arthritic joints and discs.
Osteoporosis occurs with increasing frequency over the age of 70 years, resulting in decreased bone density and bone weakness, often causing spinal compression fractures and deformity. These fractures can be very painful and often arise after minimal impact or force. Minor fractures are treated with analgesia and bracing until the pain resolves, which may take several weeks. The osteoporosis must also be investigated and appropriately treated. Major fractures with deformity will require minimally invasive surgery. This surgery is performed by injecting bone cement into the spine (kyphoplasty) to prevent further collapse and relieve pain.
Dr Jacques De Wet was born and raised in Gauteng and completed his undergraduate degree in medicine at the University of Witwatersrand. He completed his internship at Baragwanath Hospital before relocating to Pietermaritzburg. At the UKZN Nelson Mandela School of Medicine, he earned a Higher Diploma in Orthopaedics as well as specialisation as an Orthopaedic Surgeon. He then spent a further six years at Edendale Hospital, serving as HOD of orthopaedics from 2014 till 2017. Dr De Wet, who is happily married with two children, has lectured extensively on trauma and limb reconstruction locally and abroad. Special interests include spines, trauma, bone infection, limb reconstruction, arthroplasty and arthroscopy.
Maritzburg Orthopaedic Centre has a tradition of excellence in orthopaedic care, and the fine reputation of its surgeons is known throughout KwaZulu-Natal. Each surgeon in the group is board certified and many have additional sub-speciality training.
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