Let's learn about your lower back (Lumbar Spine) What exactly is this?

Do you sometimes have lower back pain? When you sit in one place for a long time, or when you lift a heavy load, the lower back is the most stressed part. So, today we will talk about the lower back, which is a very important part of our body, or as doctors call it , the lumbar spine . Let's simply understand what it is, what services it provides to our body, what problems it can cause, and what are the solutions to them.

What is the Lumbar Spine?

Simply put, the lumbar spine is made up of five bones (also called vertebrae) at the bottom of your back. Doctors call these five bones L1, L2, L3, L4, and L5. (The L stands for lumbar.) These lumbar vertebrae are a little larger and thicker than the other vertebrae in your entire spine, like a square boulder.

Imagine, the lumbar spine is located below the 12 vertebrae in your chest (these are called the thoracic vertebrae) and above the triangular-shaped bone called the sacrum, which is even lower.

Because these lumbar vertebrae are large, they provide good stability to our spine. Also, many muscles and ligaments come and connect to this part. Most importantly, this lumbar spine bears the most weight of your body. Not only that, it also helps you maintain your balance. The muscles and ligaments attached to this lumbar spine help you walk, run, sit, lift things, bend and twist your body in all directions.

Your lumbar spine has a slight inward curve. It's called a lordotic curve .

What happens to the lumbar spine?

Let's look at some of the things that happen to our lower back:

• It supports your upper body and distributes your weight: It is the lumbar spine that supports the weight of your head, as well as the seven vertebrae in your neck (called the cervical spine) and the twelve vertebrae in your chest (the thoracic spine). It is also connected to your pelvis, which bears the most weight in your body and bears the pressure when you lift or carry something. It is the part that transfers the weight of your upper body to your legs.
• Helps you move your body: The muscles in your lower back and the flexibility of your lumbar spine allow you to bend your torso in all directions (forward, backward), bend to the side, fully rotate, and twist. The last two lumbar vertebrae (L4, L5) in particular help with these movements the most.
• Protects Your Spinal Cord and Cauda Equina: The spinal cord, which runs through your spine, is like a main nerve root that comes from your brain. It starts at the base of your skull and ends at the first lumbar vertebra (L1). Then, there is a bundle of nerves that runs down from the end of the spinal cord. It is called the cauda equina (horse's tail) because it looks like a horse's tail. The spinal cord and the cauda equina are protected by a covering made up of these vertebrae.
• Controls leg movements: The nerves that come out of your lower spinal cord and cauda equina control the sensations (feelings) and movements of your legs.

What muscles and other soft tissues are in the lumbar spine?

Muscles of the lumbar spine

Your lower back muscles, along with your abdominal muscles, move your torso and lower back. These muscles and ligaments provide strength and stability to your lower back, helping you bend forward, backward, and rotate. Here are some of the main muscles that connect to the lumbar spine:

• Latissimus Dorsi: This is a large, flat, triangular muscle. It runs along your mid and lower back. It helps you lift weights with your arms, lift your chest when you breathe, and bend your back to the side.
• Iliopsoas: This is a group of three muscles. It moves your hip joint. This muscle helps keep your hip and lower back stable when you walk, run, and get up from a chair.
• Paraspinals: These three groups of muscles are located along your spine. They help you stand upright, bend to the side, and rotate. They are also important for maintaining your posture.

Discs in the lumbar spine

Intervertebral discs are the parts of the spine that act like "shock absorber cushions" between two vertebrae. There are five of these discs between your lumbar vertebrae. In addition to absorbing shock, these discs also help support the weight that travels down your spine and allow for movement between the vertebrae.

Important: This disc in your lower back is the one that is most likely to degenerate or herniate. This is when you start to feel pain in your lower back, or down your legs, sometimes into your feet.

Ligaments of the lumbar spine

Ligaments are the tissues that connect one bone to another. Ligaments in the lumbar spine help keep the spine stable, allow for smooth movement, and help absorb impact in the event of an accident. Some of the main ligaments are:

• Anterior Longitudinal Ligament: This runs down the front of the lumbar vertebrae. It stabilizes the lumbar joints and limits backward flexion (extension).
• Posterior Longitudinal Ligament: This runs along the back of the lumbar vertebrae. It limits forward flexion.
• Supraspinous ligament/Interspinous ligament: These ligaments also help limit forward flexion.
• Ligamentum Flavum: These cover the inside of the spinal canal and protect the spinal cord from behind.
• Intertransverse ligaments: These connect the transverse processes of the vertebrae. They help to resist lateral bending of your torso.
• Iliolumbar ligament: This runs from the L5 vertebra to the pelvic bone. It helps stabilize the lumbosacral spine.

Spinal Cord and Nerves

As we have already discussed, the spinal cord is a bundle of nerve tissue that extends from the brain to the L1 vertebra. This is what carries messages from the brain to the muscles. The nerve roots that go down after L1 are called the cauda equina .

Five pairs of nerves exit your lumbar spine (L1 through L5, one on each side). These nerves travel down your spine and join with other nerves to form a network of nerves that control pain, sensation, and movement in your lower limbs.

• L1 nerve: Provides sensation to your groin area and genitals, and helps move your hip muscles.
• L2, L3, L4 nerves: Provide sensation to the front of your thigh and the inside of your lower leg. They also control hip and knee muscle movement.
• L5 nerve: Provides sensation to the back of your lower leg, the top of your foot, and the area between your big toe and second toe. It also controls movement of your hips, knees, feet, and toes.
• Sciatic Nerve: This is formed by the L4, L5, and other sacral nerves. It starts in your buttock, runs down your leg, and ends in your foot. Sciatica pain occurs when this nerve is damaged or compressed.

Blood Vessels

The vertebrae, muscles, and ligaments in the lumbar region receive blood and nutrients from branches coming from the abdominal aorta, the main artery in your abdomen.

What diseases and disorders affect the lumbar spine?

Unfortunately, this lower part of our spine can suffer from a variety of problems. These problems can limit the range of motion in your back or hips, and can cause pain, weakness, and numbness in your back, hips, thighs, or legs.

Some of the diseases and conditions that affect the lumbar spine are:

• Lower back pain: This is a common problem for many people. It can be caused by a variety of injuries and medical conditions. Back pain can be caused by degenerative diseases (e.g., Osteoarthritis , Ankylosing Spondylitis ), spinal stenosis , herniated discs , pinched nerves, sprains, spinal fractures, tumors, cysts, bone spurs, and spondylolisthesis (slipping of a vertebra).
• Lumbar Stenosis: This is a narrowing of the space around your spinal cord. This reduces the space for the nerves that exit the spinal cord. This can cause nerve compression, pain, numbness, weakness in the legs, groin, hips, buttocks, and lower back. These symptoms may worsen when walking or standing, and may be relieved by lying down, sitting, or bending forward slightly.
• Spondylolisthesis: This is when a lumbar vertebra slips forward relative to the vertebra below it. This can compress a nerve and cause back or leg pain.
• Vertebral Compression Fracture: A person with a condition like osteoporosis can suffer a vertebral compression fracture from even a minor accident. Severe fractures can also occur from things like car accidents and falls from heights.
• Sciatica: Also known as lumbar radiculopathy , this is nerve pain caused by damage or irritation to the sciatic nerve. It can be caused by things like a herniated disc, spondylolisthesis, or osteoarthritis.
• Herniated Disk: This occurs when the disc between the vertebrae bulges, tears, or leaks its contents. It can cause back pain, numbness in the legs, and muscle weakness.
• Lumbar Lordosis (also known as "Swayback"): This is an excessive curvature of the lower back. This puts unnecessary pressure on the lumbar vertebrae. This can be caused by diseases, poor posture, and excessive bending of the spine.
• Muscle Spasm: There are large muscles that support the lumbar region. These muscles can become tense or twisted. This is also a common cause of back pain.
• Degenerative Disk Disease: This condition occurs when the discs in the lumbar spine wear down. The space between the vertebrae decreases, which can cause nerve compression and back pain.
• Adult Scoliosis: Scoliosis is a sideways curvature of the spine. This condition can occur in the lumbar spine as we age or as the spine wears out.
• Cauda Equina Syndrome: This condition is caused by compression of the nerve bundle called the cauda equina. This is a medical emergency . Symptoms include pain, weakness, and loss of bowel and bladder control.

How are diseases and conditions of the lumbar spine diagnosed?

First, your doctor will ask you about your medical history, medications you take, and symptoms. Then, they will perform a physical exam and order tests and scans if necessary.

You can do tests like this:

• CT Scan (Computed Tomography - CT Scan): This uses X-rays and a computer to take very thin "slice" pictures of the area being examined. It can look at things like the shape and size of the spinal canal, and the condition of the bones (bone spurs, bone fusion, bone destruction due to infection or tumors).
• Magnetic Resonance Imaging (MRI): This uses a large magnet, radio waves, and a computer to take detailed pictures. It can help diagnose problems with the spinal cord and nerves that come out of the spine, such as herniated discs, infections, and tumors. An MRI gives a clearer picture of the nerves than a CT scan.
• X-rays: Uses a small amount of radiation to take pictures of bones and soft tissues. They can look for things like fractures, disc problems, spinal stenosis, and arthritis.
• Electromyogram (EMG) and Nerve Conduction Studies: An EMG checks the health and function of nerves and muscles. A nerve conduction study measures how quickly an electrical impulse travels along a nerve. These tests can help identify nerve damage and where the nerve is compressed.
• Myelogram: This test looks at the connections between the vertebrae and discs, the spinal cord, and the nerve roots. It can check for a tumor, bone spur, or herniated disc that is pressing on the spinal cord or nerves, causing pain, numbness, or weakness.

How are lumbar spine health problems treated?

There are both non-surgical and surgical treatments for many conditions affecting the lumbar spine. The treatment method you choose will depend on the cause of the problem and its severity.

What are non-surgical treatments?

If your lower back pain isn't caused by an accident or a tumor, your doctor may recommend less invasive treatments first. Some common non-surgical treatments include:

• Rest.
• Ice or hot compress.
• Avoiding work that is tiring or increases pain.
• Physical Therapy.
• Medications: muscle relaxants, painkillers (e.g. paracetamol), and anti-inflammatory medications (e.g. ibuprofen, naproxen).
• Steroid Injections: There are three types of steroid injections that can be considered for lumbar pain. Lumbar Epidural Block is a steroid injection into the epidural space outside the spinal cord. Lumbar Facet Joint Block is a steroid injection into the facet joint between the vertebrae. Interlaminar Injection or Transforaminal Injection is a steroid injection into the space between the spinal cord and the spinal cord.
• Medical Branch Block and Radiofrequency Ablation: This treatment is considered for some chronic lumbar pain. First, a local anesthetic is injected into the nerve that connects to the facet joint of the spine. If the pain decreases, the next step is to try to permanently eliminate the pain. This is done by damaging the nerve with a technique called radiofrequency ablation . The pain has been reduced for months. However, if the nerve grows back, the pain can return.

How do I know if I need lumbar spine surgery?

You may need lumbar spine surgery if:

• If other treatments don't help.
• If your lower back, hip and/or leg symptoms get worse (surgery is usually done for leg pain rather than back pain).
• If you are healthy enough to undergo surgery.

If you have an injury to the lumbar region from an accident (such as a car accident), cancer, epidural abscess (an infection between the spinal cord and the covering of the spinal cord), osteomyelitis (an infection of the bone), cauda equina syndrome, or conus medullaris syndrome (a type of spinal cord disorder), surgery is the first line of treatment.

What surgeries are available for lumbar spine conditions?

Here are some commonly performed surgical procedures:

Lumbar Spinal Decompression Surgery

This is a general term. It refers to a variety of surgical procedures that are performed to relieve symptoms by reducing pressure or compression on the spinal cord or nerve roots. Common surgical techniques include:

• Lumbar Diskectomy: In this, the surgeon removes part of a disc to relieve pressure on nearby nerve roots.
• Lumbar Laminotomy or Laminectomy: In this procedure, the surgeon removes a small section of the bony arch (lamina) of the spinal canal. In a laminotomy, only a small piece of the lamina is removed. In a laminectomy, the entire lamina is removed, along with any bone spurs, disc fragments, and thickened ligaments, if necessary. When the lamina is removed, the spinal canal is widened and pressure is relieved.
• Lumbar Foraminotomy or Foraminectomy: Both of these surgeries are performed to enlarge the opening (foramen) through which the nerve roots exit the spinal cord, by removing some of the bone in that area. In a foraminectomy, a large amount of bone is removed.
• Lumbar Corpectomy: In this surgery, the surgeon removes the main part of the vertebra (vertebral body) and the disc to relieve pressure on the spinal cord. Sometimes, the vertebrae are then fused together ( spinal fusion ) to stabilize the lumbar spine.

Lumbar Disk Replacement Surgery

In this, a diseased lumbar disc is removed and an artificial disc is inserted. This is often done for lumbar disc replacement. However, in recent years, this surgery has become less common, due to complications that occur after the surgery.

Lumbar Spinal Fusion

This is a surgery that permanently fuses one or more lumbar vertebrae together, eliminating movement between the vertebrae.

Functional Electrical Stimulation for Spinal Cord Injury

In this method, small electrical impulses are used to activate the muscles and nerves of the lower body controlled by the lumbar nerves, attempting to restore their function.

Can I have minimally invasive lumbar spine surgery?

Talk to your surgeon about this. In many cases, minimally invasive spine surgery has replaced traditional open surgery. Rather than making one large incision in the skin, minimally invasive surgery is performed through one or more small incisions. Because the incisions are small, there is less damage to the muscles and soft tissues than with a large incision.

The most important things to remember (Take-Home Message)

Your lumbar spine is the lower part of your back. It has five vertebrae (L1-L5). It also contains the intervertebral discs, the spinal cord, and nerves, muscles, tendons, and ligaments. It is the lumbar spine that supports your body's weight and allows for most of your body's movement.

The most important thing is, if you have persistent lower back pain, numbness in your legs, or weakness, don't ignore it. Definitely see a doctor and get advice.

There are both non-surgical and surgical treatments for many conditions. So there's nothing to worry about. You can also help keep your lumbar spine healthy by maintaining proper posture, lifting weights correctly, and exercising.

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