What causes pain in the lower back and legs?

What is lower back pain?

Spine pain is one of the most common reasons people seek medical treatment, or practice self-care at home. While lower back pain often can be treated conservatively, one third of people who experience back pain will have a recurrence within a year.

Lower back pain can be caused by many things, such as improper lifting, an injury, arthritis, or spine conditions that affect the vertebrae, discs, or nerves in the spine. Things like improper lifting, accidents or injuries tend to cause acute, or short term, lower back pain. Arthritis and issues with the spinal vertebrae, discs, or nerves tend to cause chronic, or long term, spine pain. On this page, we will provide an overview of the common spine conditions that cause lower back pain as a result of a spinal condition or an identifiable structural cause.

What part of the spine is the lower back?

The spine is composed of 24 vertebrae, or bones of the spine, separated by gel-like discs. Your spinal cord ends at the top of the low back portion of the spine, which is called the lumbar region. Nerves branch off of the spinal cord between the vertebrae and continue down into the arms and legs. Spine pain is usually classified by the part of the spine in which it occurs:

• Cervical spine: the neck, composed of seven vertebrae numbered C1 to C7
• Thoracic spine: the upper and mid back, where your ribs attach to the spinal column, including twelve vertebrae numbered T1 to T12
• Lumbar spine: the lower back, composed of five vertebrae numbered L1 to L5

Many of the spine conditions that cause pain can occur in any area of the spine. Pain can occur due to problems with the vertebrae (bones), the discs between the vertebrae, or the spinal nerves. Common spine conditions are divided into five categories:

• Degenerative
• Traumatic
• Infectious
• Neoplastic
• Spinal deformity

What common conditions cause lower back pain?

Medical conditions that commonly cause lower back pain are outlined below. Additional detailed information on each condition and treatment options are provided on linked pages.

Degenerative Spine Conditions

Degenerative spine conditions result in a “breakdown” of function and normal structure of the spine over a period of time, which may result in back pain and neck pain. These conditions are most often caused by aging. Tumors, infections, or arthritis also can lead to some of these conditions. Common degenerative spine conditions are listed below.

Degenerative disc disease – A common source of lower back pain, degenerative disc disease evolves gradually as the discs lose flexibility, elasticity, and shock-absorbing characteristics through normal wear and tear in the process of aging.

Bulging discs – Bulging discs are sometimes called disc protrusions or disc herniation. They may cause symptoms such as pain in the arms/legs, numbness, tingling, and weakness of the arms and/or legs if they press on an adjacent nerve root or the spinal cord.

Herniated discs (also called disc herniation or slipped disc) – A herniated disc is similar to a bulging disc, but in addition to the disc protruding, the soft inside of the disc breaks through the outer covering. It often can compress nearby nerves, resulting in pain, numbness, tingling or weakness in an arm or leg. Disc herniation is often the result of degenerative disc disease caused by aging, but it can also occur with events such as trauma or even improper lifting.

Radiculopathy – Radiculopathy occurs when a nerve in the spine is compressed and nerve inflammation occurs. It most commonly occurs in the lower back and the neck. It can result from a number of other spine conditions, including disc herniation and degenerative disc disease. Symptoms of radiculopathy include pain, tingling, numbness or weakness in the arms and legs. Most initial treatment options for radiculopathy are non-invasive and may include medications, injections, and physical therapy.

Sacroiliac (SI) joint dysfunction – One quarter of low back pain is actually caused by problems in the joint that connects the spine to the hips, called the sacroiliac joint or SI joint. This is the most common misdiagnosed condition that causes back pain, often because it can be caused by previous spine fusion.

Spinal stenosis – Most often occurring in the neck or lower back, spinal stenosis is created when the spinal column narrows, which can be caused by a series of issues including overgrown bone, herniated disks, tumors, and spinal injuries. This puts pressure on the spinal cord and the nerves that travel through the spine. The pressure can cause pain, numbness, tingling, balance dysfunction, and in rare cases: muscle weakness, incontinence, and problems with bowel function.

Spondylolisthesis – Spondylolisthesis occurs when one vertebra slips forward relative to another vertebra. Spondylolisthesis can occur in the neck or low back and symptoms can include lower back pain, leg pain, weakness, numbness and/or tingling in the legs.

Myelopathy – Myelopathy is a condition in the neck or mid back in which the spinal cord is irritated or injured. Symptoms include numbness and tingling, weakness in the arms and legs, changes in balance, fine motor function and in severe cases bowel and bladder dysfunction.

Synovial cyst – A fluid-filled sac in the joints of the spine, usually in the lumbar area, that has developed as a result of arthritis and may compress nerves like a herniated disc. Symptoms of a synovial cyst are similar to spinal stenosis and typically include pain in the lower back that radiates down one or both legs.

Facet arthropathy – A type of arthritis that affects the joints that connect the vertebrae, facet arthropathy can occur when the protective cushioning between the facet joints breaks down and becomes thinner. This allows the bones of the facet joint to rub together, causing pain that often shows up as back or neck pain.

Scoliosis – Adult onset scoliosis or degenerative scoliosis can occur slowly over time as a person ages. This side-to-side curvature of the spine is caused by degeneration of the facet joints and intervertebral discs. In rare cases, the spine develops a curvature to compensate for the wear and tear that has occurred.

Most often, degenerative spine conditions require conservative treatment and may improve through simple exercises and strengthening. If conservative treatments fail, surgery may be recommended.

Can trauma or infection cause lower back pain?

In addition to degenerative conditions, lower back pain can be caused by trauma, infection, tumors, or spinal deformities.

Traumatic Spine Conditions
Spine conditions that are related to trauma can occur from events such as car accidents, sports injuries, and falls. Trauma-related spine conditions typically result in sprains, fractures, and bone dislocations in the spine. Depending on the number of vertebrae involved, certain injuries can cause compression or wedge fractures and may lead to a spinal deformity, such as kyphosis. Treatments for traumatic spine conditions vary depending on the severity of the injury and may include immediate surgery.

The spine surgeons at Neurosurgery One are trained trauma specialists and provide on-call coverage to St. Anthony Hospital in Denver, a Level I Trauma Center, Littleton Adventist Hospital and Parker Adventist Hospital, Level II Trauma Centers, and Castle Rock Adventist Hospital, a Level III Trauma Center.

Infectious Spine Conditions
Spinal infections can occur following a surgery or can spread from an infection in a different part of the body. Certain risk factors increase the chances of contracting an infection in the spine, including poor nutrition, immune suppression, diabetes, and certain cancers. Spine conditions that are caused by infection include:

• Vertebral osteomyelitis
• Discitis
• Spinal epidural abscess
• Meningitis

Most cases of infectious spine conditions can be treated with antibiotics. You may require hospitalization if your infection is acute. In rare cases, surgery may be necessary if there is severe impact to a bone, neurological structure, or if the condition is not responsive to antibiotics.

Can cancer cause back pain?

Neoplastic spine conditions are benign or malignant tumors in the spine. In the lower back, these occur most commonly in the vertebrae. In the middle or upper back or neck, the tumor can compress the spinal cord and damage nerves, causing neurological problems and possible paralysis. Progression of such tumors depends on the specific type of tumor. Treatment for neoplastic spine conditions may include spine surgery, radiation therapy, and chemotherapy. Recent studies show that patients tend to have better functional outcomes with surgery and radiation than with radiation alone.

What congenital conditions in adults cause lower back pain?

Congenital spine conditions or changes to the spinal structure occur when there is a curvature in the spine. Most spinal deformities are non-progressive but can cause persistent pain that can become debilitating. Spinal deformities include:

• Scoliosis – is a side-to-side curvature of the spine that typically occurs in childhood but continues to affect people throughout their lives. Scoliosis also can occur in adults as a result of aging, which is then considered a degenerative spine condition.
• Kyphosis – Kyphosis is a forward rounding of the back that commonly occurs in older patients with osteoporosis. It may cause pain or compression fractures of the spine.
• Lordosis – Sometimes called swayback, lordosis is a significant inward curve in the lower back.

Many treatment options are available based on the severity of the condition. Options include bracing to correct spine curvature, physical therapy, and spine surgery.

How is lower back pain diagnosed?

While some lower back pain is caused by improper lifting, injury, or strains and resolves on its own, persistent or recurring back pain can be a symptom of an underlying medical condition. To determine the exact origins of your pain, a spine specialist provider at Neurosurgery One will take your medical history, ask you about the location, frequency, and duration of your pain, and perform a specialized physical exam. Depending on your symptoms, we may recommend an imaging test or scan, such as:

• Spine X-ray is used to identify degenerative disease, fractures, or even tumors.
• CT scans of the spine produce detailed, cross-sectional images of the spine, which can help detect subtle changes in bones.
• Spine MRI shows both tissue and bone and is useful in diagnosing a bulging, protruding, or herniated disc, or pinching of the nerves or spinal cord.
• Myelogram uses a special dye that is injected into the area around the spinal column, to allow better viewing of the spinal canal and discs, and the condition of nerves in and around the spine; it is used primarily when patients have had multiple prior surgeries.
• Electrodiagnostic testing studies the electrical activity of nerves in your arms and legs.
• Bone scans identify abnormalities of the bone, such as tumors or inflammation.

How is lower back pain treated?

Once a cause of your lower back pain is identified, your spine surgeon will develop a treatment plan for you. If you are diagnosed with certain traumatic or neoplastic spine conditions, or you have a spinal deformity, spine surgery may be the recommended treatment.  But for many spine conditions, conservative treatments will most likely be recommended as a starting point. Our Neurosurgery One spine specialists always begin with conservative treatments, if possible and appropriate, and may refer you to one of our pain management physiatrists. We also may recommend physical therapy or specific exercises to help relieve your pain. We work hard to ensure that you understand your condition and all treatment options available to you. We can provide you with the medical research backing our recommendations, and we partner with you to develop a personalized treatment plan that is tailored to you and your spine condition.

What exercises or pain management options treat lower back pain?

The most common first-line treatments for back pain that our spine specialists recommend include:

• Medications including nonsteroidal anti-inflammatory drugs (ibuprofen), muscle relaxants, antidepressants, and anti-seizure drugs.
• Steroid injections that can reduce inflammation and relieve pain and pressure. The number of injections a patient can receive are limited and are not meant to be used long term due to the side effects of the steroids.
• Physical therapy, combining exercise, ice, heat, and ultrasound to reduce pain and muscle spasms. Our Denver spine specialists have found physical therapy—and exercise in general—to be one of the most effective treatments for back pain and we work closely with trained physiatrists as well as physical therapists and other providers of specialized spine care to develop treatment plans.
• Alternative medicine such as acupuncture, to help alleviate pain in some patients.
• Other pain management procedures may be appropriate depending on your condition.

No matter which conservative treatment is recommended, it’s important to note that you may not experience immediate relief. It may take several months or more before you start to feel better. Patients should not assume these treatments are ineffective until some time has passed to allow the treatment to start working. Our spine team will monitor your progress and discuss when to discontinue conservative treatment and begin to consider surgery.

When do I need surgery for lower back pain?

While the vast majority of people with lower back pain will improve over time without medical treatment or with non-surgical treatments, you may need surgery to treat the condition causing your lower back pain. Typically, you are a candidate for spine surgery if you meet these criteria:

• A structural problem has been diagnosed and confirmed through imaging (such as an X-ray or MRI)
• Conservative treatments, such as physical therapy or medications, have failed to provide adequate pain relief
• Your lower back pain is debilitating, meaning it is preventing you from participating in daily activities or physical activity
• Your lower back pain is negatively impacting your physical or emotional health
• There is a reasonable expectation that you will benefit from spine surgery
• If your neurological system is being affected, and your general health and age supports spine surgery without creating an undue health risk

Our Denver spine surgeons will help you understand if spine surgery will benefit you, the right time to consider spine surgery, and the best type of spine surgery for your condition—and for you.