Back pain is one of the most common complaints heard by physicians. In fact, four out of five adults will experience an episode of significant back pain sometime during their life, according to the North American Spine Society.

Pinpointing the exact source of back pain is often difficult, with numerous possible sources including muscles, soft connective tissues, ligaments, discs, cartilage and nerves.

Texas Health Resources has a multidisciplinary team of experts who can quickly and effectively diagnose the source of back pain and provide you with a range of treatment options. Texas Health has back specialists on the medical staff who can perform advanced surgeries, as well as make recommendations about other treatments. Many Texas Health hospitals offer rehabilitation services with advanced equipment and experienced therapists. Plus, you can try these tips for keeping your back healthy and pain free.

Learning to lift and bend properly is essential to preventing back pain. Follow these tips:
• If an object is too heavy or awkward, get help.
• Spread your feet apart to give you a wide base of support.
• Stand as close to the object you are lifting as possible.
• Bend at your knees, not at your waist.
• Tighten your stomach muscles as you lift the object or lower it down.
• Hold the object as close to your body as you can.
• Lift using your leg muscles.
• As you stand up with the object, DO NOT bend forward.
• DO NOT twist while you are bending for the object, lifting it up or carrying it.

Other measures to prevent back pain include:
• Avoid standing for long periods of time. If you must stand for your work, try using a stool. Alternate resting each foot on it.
• DO NOT wear high heels. Use cushioned soles when walking.
• When sitting for work, especially if using a computer, make sure that your chair has a straight back with an adjustable seat and back, armrests, and a swivel seat.
• Use a stool under your feet while sitting so that your knees are higher than your hips.
• Place a small pillow or rolled towel behind your lower back while sitting or driving for long periods of time.
• If you drive long distance, stop and walk around every hour. Bring your seat as far forward as possible to avoid bending. Don't lift heavy objects just after a ride.
• Quit smoking.
• Lose weight.
• Do exercises to strengthen your abdominal muscles on a regular basis. This will strengthen your core to decrease the risk of further injuries.
• Learn to relax. Try methods such as yoga, tai chi or massage.

Your physician will diagnose your back pain based on the findings of a medical history, physical exam and diagnostic tests.

For your medical history, the physician may ask questions such as:
• When did your back first begin to hurt?
• Do you feel the pain continuously or off and on?
• Is the pain in your entire back or one specific location?
• What activities seem to aggravate the back pain?

During the physical exam the physician may examine your range of motion and nerve function and touch your body to locate the area of discomfort.

Depending on the findings of the medical history and physical exam, your physician may use one or more of the following tests to determine the source of your back pain:
• X-ray
• Computed tomography (CT) scan
• Magnetic resonance imaging (MRI)
• Electromyogram

Texas Health hospitals have advanced equipment, such as 64-slice CT scanners, for diagnosing back problems.

Common diagnoses for back pain include:
• Abnormal discs that may be degenerating, bulging or herniated
• Spinal stenosis (narrowing of the spinal column that causes pressure on the spinal cord)
• Tumors
• Fractures

Most back problems can be taken care of with nonsurgical treatments, such as anti-inflammatory medication, ice, heat, gentle massage and physical therapy. However, when these more conservative treatments do not help, your physician may recommend a type of back surgery.

Surgical treatment options include: Minimally invasive surgery: Neck and back surgeries performed with new instruments and techniques that require smaller incisions, resulting in less tissue disruption, less post-operative pain, shorter hospital stays and faster recovery times compared to traditional open surgery.

Microendoscopic discectomy: A minimally invasive surgical technique used to remove a herniated disc in the cervical or lumbar spine. A ruptured disc can press on nerves and cause symptoms such as extremity pain, numbness, weakness, electrical sensations, and bowel and bladder incontinence. Microendoscopic discectomy differs from open microdiscectomy by using a smaller incision (approximately 1 cm). The procedure usually takes about one hour, and the patient is often able to return home on the same day.

Total disc replacement: Surgery that treats painful degenerative disc disease of the cervical and lumbar spine; this approach is designed to preserve motion of the disc space while reducing or eliminating pain. Possible candidates for this procedure must have undergone at least six months of unsuccessful conservative care and meet other criteria.

Anterior cervical discectomy and fusion: An operation performed on the upper spine to relieve pain and other symptoms in the neck, arms, and legs caused by pressure on the spinal cord or other nerves. In this operation, the surgeon reaches the cervical spine through a small incision in the front of the neck. The damaged disc is removed, and a bone graft is placed between the two vertebrae. Over time, this bone graft will create a fusion between the vertebrae so that pain-causing motion is eliminated. Usually a small cervical plate is used to stabilize the spine immediately after surgery and decrease the chance that the bone graft might be dislodged.

Anterior lumbar interbody fusion (ALIF): An operation performed on the spine through an incision in the abdomen; a portion of the affected disc space is removed and replaced with an implant and bone graft. In some patients, surgeons can use Bone Morphogenetic Proteins as bone graft material instead of bone taken from another part of the patient's body. This shortens operative time and eliminates pain associated with harvesting healthy bone for the graft. Titanium or stainless steel screws and rods also may be inserted into the back of the spine to supplement the stability of the entire structure.

Minimally invasive posterior lumbar fusion: An operation performed on the spine from the back through one-inch (25mm) incisions; utilizing minimally invasive techniques, a surgeon removes a portion of the affected disc space from the spine and replaces it with an implant and bone graft. For some patients, surgeons use Bone Morphogenetic Proteins so healthy bone does not have to be harvested; metal hardware provides added stability. This procedure is for patients suffering from back and/or leg pain, especially those who have had previous abdominal surgery.

Posterior lumbar fusion: Sometimes called posterolateral spinal fusion, this open surgery treats a disc space that has degenerated to the point that movement causes back and/or leg pain. It is performed through an incision made in the back and entails inserting a bone graft into the affected space. Titanium or stainless steel screws and rods also may be inserted into the back of the spine for added stability. If fusion is successful, motion between the vertebrae stops and pain is relieved.

360 lumbar spinal fusion: A fusion surgery performed on the lower back that uses a specially angled implant to replace a damaged disc. The device is introduced from the front (anterior) of the body and held in place by screws introduced from the back (posterior) to provide more strength and stability after bone grafts heal. This procedure is recommended for younger, more active patients and those who have previously had back surgery.

Back surgery is a major undertaking, and a dedication to working at rehabilitation is essential for getting the most benefit from the surgery. Patients will receive written instructions concerning rehabilitation when they leave the hospital, and their physician may prescribe specific rehabilitation services.

Many Texas Health hospitals offer rehabilitation services with advanced equipment and experienced therapists. Rehabilitation usually includes training and exercise with a physical therapist.

Q: If I am experiencing back pain, what are some signs that would indicate that I should see a physician?

A: Call your health care provider if you have persistent, severe back pain, especially if you have also have numbness, loss of movement, weakness, or bowel or bladder changes.

Q: What is degenerative disc disease?

A: Degenerative disc disease is not really a disease but a term used to describe the changes of the discs in the spine resulting from chronic wear and tear, injury or simply aging. Spinal discs are compressible, soft discs that separate the bones that make up the spine. The discs act as shock absorbers for the spine, allowing it to flex, bend and twist. Changes to the discs can include loss of fluid in the discs, tears of the outer layer of the disc and growth of nerve fibers in the damaged discs.

Q: What is the difference between a herniated disc and a bulging disc?

A: A bulging disc occurs when the tough outer fibers of the spinal disc weaken and stretch allowing the "jelly center" of the disc to "bulge" outward. A bulging disc is generally considered the first step toward a herniated disc. A herniated (slipped) disc occurs when all or part of a spinal disc is forced through a weakened part of the disc, which places pressure on nearby nerves.

Q: What is spinal stenosis?

A: Spinal stenosis is narrowing of the spinal cord that causes pressure on the spinal cord, or narrowing of the openings (called neural foramina) where spinal nerves leave the spinal column. Spinal stenosis typically develops as a person ages and the discs become drier and start to shrink. At the same time, the bones and ligaments of the spine swell or grow larger due to arthritis or chronic inflammation. However, other problems, including infection and birth defects, can sometimes cause spinal stenosis.

Q: If I have chronic back pain, will I need back surgery?

A: Surgery is only recommended when nonsurgical methods have not provided adequate relief from the pain. Physicians will usually recommend treatments such as physical therapy, medications, coping skills, procedures and alternative medicine treatments before recommending surgery. In fact, according to the North America Spine Society, only one percent of back pain sufferers need surgery.