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The lower back is also called the lumbar spine area. It is the strongest portion of the spinal column and extends from the mid to lower back.

Five vertebrae compose the lumbar spine with disks situated between each one. Lower back pain or injury affects a large number of people.

The anatomical structures that make up the lower back are diverse and at times it may be difficult to determine the exact nature of lower back discomfort as any of these structures may be causing direct or referred pain. Both acute and chronic lower back conditions required an accurate diagnosis for proper treatment and pain management.

Lower Back/Lumbar Spine Injuries

The lumbar spine may suffer an injury when there is impact of great force against the spinal column. When this happens, the spinal cord, vertebrae or disks may become damaged, leading to symptoms such as pain, numbness or weakness. These symptoms may vary from person to person depending on the type of injury and the strength of the spinal column.

Tests

Your doctor can rule out spinal cord injury through inspection of the back, evaluating your sensory function and inquiring about the trauma.

Diagnostic tests may be required in case there is also neck pain or signs of neurological injury. These tests include the following:

• X-rays - X-rays are usually performed on those who have suffered trauma to the back and spinal cord injury is suspected. An X-ray can provide insight about fractures to the spine, problems in the spinal column as well as tumours.
• Computerized tomography (CT) scan - In case an x-ray reveals certain abnormalities, a CT scan will enable a more detailed evaluation of these problems. In a CT scan, cross-sectional images highlighting the disk, bone and other areas are obtained with the use of computers.
• Magnetic resonance imaging (MRI) - In these tests, computer generated images are obtained using magnetic field and radio waves. This test enables a doctor to detect herniated disks, clots or other problems that may be pressing against the spinal cord.
• A neurological exam may be ordered sometime after the injury when the swelling has reduced to some extent. This exam involves testing of muscle strength and sensation of touch or a pinprick. This helps to rule out further problems.
• In some cases, a bone scan or electromyogram may help to detect bone or nerve conditions that may be the source of lower back discomfort.

Here is some additional information about tests for lower back/spinal injuries:

• Imaging tests are costly and may not always be suitable for acute lower back pain since they do not usually yield any beneficial early information. They are helpful mostly in case of serious conditions such as spinal infection or cancer, or in case lower back pain has persisted for more than three weeks with non-surgical treatment.
• An MRI is the most effective test for detecting herniated disks, infection, tumours or damage to the soft tissues of the spinal column. MRI does not make use of ionizing radiation which is used in CT scans.
• In some cases, a doctor may find it difficult to determine if a compression fracture of the vertebrae is due to recent trauma or due to infection, cancer or osteoporosis. In such cases, MRI is helpful as a testing tool as the treatment will differ depending on the cause of the fracture.

How are lower back injuries treated?

A spine specialist, after determining the location and nature of the injury, will decide if surgical treatment is needed. In case surgery is not necessary, you may need to wear a brace for a period of time specified by your doctor.

References

• Elizabeth Huntoon, Marc Huntoon, Differential diagnosis of low back pain, Seminars in Pain Medicine, Volume 2, Issue 3, September 2004, Pages 138-144, ISSN 1537-5897, http://dx.doi.org/10.1016/j.spmd.2004.08.003