Treatment of low back and spine pain in Zaporizhzhia
The most common reason people come to a neurosurgeon. Most often this is not a herniation but an overload of the muscles and joints of the spine: a sharp catch after an awkward movement, a dull ache by evening, stiffness in the morning. Surgery is not needed in that situation, and scans in the first weeks are usually not needed either.
But there are a few situations in which back pain calls for an urgent examination, and it is important to tell them apart.
- Symptoms
- pain in the lower back, stiffness, sometimes shooting into the leg
- Work-up
- if it lasts over a month - MRI of the lumbar spine, blood tests
- Without surgery
- the vast majority of cases, 2–6 weeks
- Surgery
- only with confirmed nerve compression
- Consultations
- room 211, Mon-Fri 08:30-15:00
Back pain is almost always benign. But these signs mean it must not be put off:
- Disturbed urination or bowel control, numbness in the groin - call 103 (ambulance).
- Weakness in both legs, or rapidly increasing weakness in one.
- Pain at night at rest that wakes you and does not depend on your position.
- Fever, weight loss, night sweats together with back pain.
- Pain after an injury - a fall, a traffic accident, especially in older age or with osteoporosis.
- A previous cancer and new back pain.
None of these automatically means disaster. But each of them is a reason not to wait for it to "pass on its own".
What happens in low back pain
The lower back carries the weight of the whole body and still has to bend. Muscles, ligaments, discs and the small joints between the vertebrae all work together. When one link is overloaded, a protective muscle spasm kicks in - and that is most often what hurts.
So ordinary low back pain is not a breakdown but a response to overload. It is not directly linked to what a scan shows: most people over forty have disc changes, and most of them have no pain at all.
Two fundamentally different scenarios have to be told apart. First: the lower back itself hurts, the pain is local and does not shoot anywhere - that is usually muscles and joints. Second: the pain runs down the leg, below the knee, with numbness - that already looks like a nerve root, and scans are needed.
Symptoms
- Aching or sharp pain in the lower back, worse towards the end of the day or after exertion.
- Morning stiffness that you have to "walk off".
- Pain on extending and turning the trunk - typical of facet syndrome.
- A sudden "shot" after which it is hard to straighten up.
- Pain radiating into the buttock and the back of the thigh.
- Pain running below the knee with numbness - that is already about a herniated disc.
- The legs seizing up after a hundred or two hundred metres - that is about stenosis.
Causes
Most often it is overload of the muscles and small joints of the spine: long periods of sitting, working bent over, lifting something heavy suddenly, unfamiliar exertion after a long break.
Less often a specific structure lies behind the pain: a disc, a facet joint, a narrowed canal, a slipped vertebra. And very rarely - infection, an osteoporotic fracture, or a tumour. It is precisely for those rare cases that the red flags above exist.
Age, sedentary work, weak back muscles, excess weight and smoking all increase the risk. Nobody is to blame for having back pain.
How we diagnose it
In the first weeks scans are usually unnecessary. If the pain is recent, there are no red flags and nothing shoots into the leg, we treat first rather than scan. An early MRI in that situation more often does harm: it finds age-related changes that have nothing to do with the pain and frightens the patient.
Scans are needed if: the pain lasts more than a month, radiates into the leg below the knee, there is numbness or weakness, or any red flag is present.
Which ones: an MRI of the lumbar spine, plus blood tests if infection is suspected. After an injury with a suspected fracture, a CT.
Scans no more than six months old if you have them, discharge summaries from previous treatment and a list of the medicines you take regularly. No scans is no reason to put off the visit: in the first weeks they are often not needed.
Bring the scans on a disc or a flash drive - I look at the images themselves, not the report: what to bring and on what.
I see patients in Zaporizhzhia, at the City Hospital of Emergency and Ambulance Care: room 211, 2nd floor, left of the lift.
How we treat it
Medication and activity modification
Physical therapy and rehabilitation
Nerve block
Denervation or ablation
Indications for surgery
Surgery for isolated low back pain is rare, and that is important to understand. Surgery helps where there is a concrete cause: a compressed root, a narrowed canal, an unstable segment. If the scans are clean and it still hurts, there is nothing to operate on, and any surgeon who offers an operation in that situation should raise questions.
Acute low back pain usually eases within two to six weeks. Chronic pain requires regular work with the muscles - there the result is measured in months and depends on you more than on the doctor.
After a block, relief comes within a few hours. After denervation the effect develops over two to four weeks.
Questions
Why does my back hurt if the scan is normal?
Because the pain more often comes from muscles, ligaments and small joints, and those do not show up on an MRI in the same way. A clean scan is good news: it rules out what would require surgery.
Do I need an MRI the first time my back hurts?
Usually not. With no red flags and no pain radiating into the leg, treatment comes first. Scans will be needed if a month later there is no improvement.
Who should I see - a neurologist or a neurosurgeon?
Start with a neurologist. You see a neurosurgeon when six weeks of treatment have not helped, when weakness is increasing, or when the MRI shows a compressed nerve.
Does a brace help?
In the acute phase and under load, yes, for a short time. Wearing it constantly weakens your own back muscles and in the end makes things worse.
Can I apply heat to my lower back?
In the acute phase it is better not to, especially if there is swelling and inflammation. Once the acute phase is over, heat and gentle movement usually help.
Call me and I will tell you what to do next
Mon-Fri 08:30-15:00. On operating days I cannot answer the phone: message the same number instead.
+380 67 901 37 01How it is treated
Procedures used for this condition. Each page covers how it goes, who it suits and how long recovery takes.
Dmytro Ivakhnenko - spine neurosurgeon in Zaporizhzhia
Spine neurosurgeon of the highest category, PhD in Medicine, associate professor, 30 years in practice. Spine and nerve surgery in Zaporizhzhia.