Causes of Lower Back Pain

Some of the common causes of back problems are disc injury (e.g., herniation and internal disc disruption, IDD) and degenerative discs. Disc degeneration affects about 12 million people in the United States, of which most are between the ages of 20 and 65. Approximately ten percent of patients with degenerative discs are candidates for some type of spinal surgery.

The intervertebral disc serves as a shock absorber, load distributor and spacer. As we age the disc normally undergoes degenerative change. The disc loses its ability to hold water, resulting in decreased ability to absorb shock and a narrowing of the nerve openings in the sides of the spine, which may pinch the nerves. The result is increased disc stiffness often accompanied by back and leg pain. The degenerative changes within the disc are universal and account for the majority of chronic low back pain seen in spine clinics. 

Unfortunately there is not a 1:1 association of disc degeneration to pain. In one study 52% of degenerative discs were found to be the source of the patients back pain. The MRI is a relatively sensitive test for the detection of degenerative changes within the intervertebral disc, but is incapable of providing a pain association.