Pinched nerves in the low back is one of the most common conditions we treat. There are a variety of terms that refer to pinched nerves in the low back: lumbar radiculopathy, sciatica, lumbar stenosis, neurogenic claudication.
What Causes Pinched Nerves in the Low Back?
There are multiple conditions that can cause pinched nerves in the low back, but the most common causes are disc herniations and spinal stenosis.
- Herniated Discs – There are a variety of different names for a herniated disc in the low back: disc bulge, disc protrusion, disc extrusion. The discs in the low back act like shock absorbers between the vertebrae (or bones) in the low back. If the soft, jelly-like center of the disc squeezes out of the strong, outer casing of the disc, it can pinch the nerves in the low back. A compressed nerve in the lumbar region is called “sciatica” or “lumbar radiculopathy”
- Spinal Stenosis – As we age, the anatomy of the spinal column changes such that bone spurs and ligaments can overgrow and narrow the space available for nerves to pass through the spinal column. This condition is called spinal stenosis. It is a degenerative condition, which means it tends to develop over time.
Diagnosing Pinched Nerves in the Low Back
The most important aspect of treating pinched nerves in the low back is an accurate diagnosis and identifying the root cause of your symptoms.
Our surgeons start off by evaluating patients for signs/symptoms of pinched nerves in the low back. These symptoms include:
- Discomfort in the lower back and buttocks that travels down the legs
- Numbness and tingling in the legs
- Tightness, cramping, or sharp, shooting pain in the buttocks and legs
- Weakness in the lower extremities
- A feeling of “heaviness” in the legs
If a pinched nerve in the low back is suspected, a diagnostic imaging test like an X-ray, CT scan, or MRI of the back may be ordered to pinpoint the source of your pain and confirm a diagnosis.
Treating Pinched Nerves in the Low Back
In most cases, pinched nerves in the low back are not a life-threatening or emergency situation. In these cases, our surgeons will talk with you to determine how severe your symptoms are, how long your symptoms have been going on for, how much of an impact these symptoms are affecting your quality of life, and previous treatments. These factors will help us determine how aggressive to get with our treatment recommendations.
Our general philosophy is to try everything possible to get our patients better without surgery, if at all possible, focusing on nonoperative strategies, which can include:
- Lifestyle modification, bracing, heat or cryotherapy
- Pain medications
- Physical therapy
- Lumbar-specific exercises
- Consultation with interventional pain management specialists who perform therapeutic spine injections
In some cases, however, surgery is the best option to help relieve pain from pinched nerves in the low back and to get our patients’ back to their normal activities as quickly as possible.
Surgical Options for Pinched Nerves in the Low Back
There are a wide variety of procedures that are available to treat pinched nerves in the low back. It is important to find a surgeon who is able to customize the surgical approach to each individual patient. Our surgeons are comfortable with a wide range of surgical techniques. Because of this, we can choose the surgery that is best-suited to each patient’s specific pathology–from the most ultra-minimally invasive endoscopic procedure to the more complex, large-scale spine reconstruction surgeries. When surgery is needed, however, our surgeons always ask: “What is the least invasive surgery we can offer to address your specific problem?”
Most of our adult spine surgeries are performed at Queens Medical Center, the largest private health care system in Hawaii (we do most of our pediatric spine surgeries at Shriner’s Hospital for Children—Honolulu). Queens Medical Center is known for its top-quality care, the most advanced equipment, and its experienced staff, so we feel it is the best facility for spine surgery in the Pacific. Surgical options can roughly be divided up into two categories: decompression surgery and spinal fusion.
Decompression Surgery
During a decompression surgery, different structures that are compressing the nerves in the low back are cleared out to make more room for the nerves. This helps to restore blood flow to the nerves, decrease inflammation of the nerve, and relieve the nerve pain running down your legs. Whenever possible, this surgery is done using cutting-edge minimally invasive instruments and techniques (microscopes, endoscopes, etc.) that result in smaller incisions and faster recovery.
Spinal Fusion
For some patients, pinched nerves require spinal fusion, where two bones in your back are connected or joined together permanently. Traditionally, spinal fusion was associated with large incisions and a potentially challenging postoperative recovery. Nowadays, we have better, less invasive ways to fuse the spine that are typically safer and easier to recover from compared to older techniques. Sometimes, this involves accessing the spine from the side or abdominal region (instead of your back) to weld two of the vertebrae together with rods/screws/cages. These surgeries have a variety of names (ALIF, XLIF, TLIF, OLIF).
Our philosophy is to avoid spine fusion whenever possible, as this is a larger surgery than decompression alone. However, different conditions require different surgical approaches. So, for each patient, we always consider what is the safest, most effective surgery for your specific condition.
What to Expect After Low Back Surgery
After low back surgery, we try to get patients up and walking as soon as possible, typically beginning on the day of surgery. Some patients, especially those who undergo minimally invasive surgery, can go home on the same day. Others may stay 1-2 days in the hospital, sometimes longer, depending on a variety of factors.
We try to get patients off pain medications as early as possible after surgery, especially heavy painkillers. After surgery, we encourage patients to walk as much as possible, but to avoid strenuous bending, lifting, twisting, and prolonged sitting in the initial recovery period. Recovery timelines and return to work can vary depending on a variety of factors.
Physical therapy can be helpful after surgery. The therapists in the hospital teach our patients how to navigate daily activities safely. Upon leaving the hospital, we often prescribe outpatient physical therapy to help speed up recovery and strengthen the muscles that support the back. These exercises will focus on enhancing the patient’s endurance, mobility, core strength, and overall function.
Surgical Treatment for Pinched Nerves in the Low Back in Honolulu, HI
Each of our surgeons have trained at some of the premier spine centers in the country and they have travelled across the US and internationally to be able to provide the most up-to-date, comprehensive spine care possible to our patients with pinched nerves in the low back.
To schedule a consultation with one of our surgeons, please call our office at (808) 691-6511.