Lumbar Spine Conditions
Understanding the most common causes of lower back and leg pain
The lumbar spine—your lower back—bears most of your body's weight and is the most common site of spine problems. This chapter covers the five most frequent lumbar conditions Dr. Greenberg treats at his Fort Wayne practice, explaining what causes them, how they're diagnosed, and when treatment becomes necessary.
Herniated Disc
Quick Overview: A herniated disc occurs when the soft inner material of a spinal disc pushes through a tear in the outer layer, often pressing on nearby nerves and causing pain, numbness, or weakness in the legs.
What Causes a Herniated Disc?
Discs act as cushions between your vertebrae. Over time, the outer layer can weaken and tear, allowing the gel-like center to bulge out. This can happen from:
- Age-related wear and tear (most common)
- Sudden lifting or twisting injuries
- Repetitive strain from work or sports
- Genetic factors that affect disc strength
Common Symptoms
- Sciatica: Sharp, shooting pain down one leg
- Numbness or tingling: Often in the foot or toes
- Weakness: Difficulty lifting your foot or standing on tiptoes
- Lower back pain: May be mild or severe
Diagnosis
Dr. Greenberg uses a combination of physical examination and imaging:
- Physical exam: Tests for nerve function, reflexes, and strength
- MRI: Shows the disc herniation and nerve compression
- X-rays: Rule out other causes like fractures or arthritis
Treatment Options
Most herniated discs improve with conservative care over 6-12 weeks:
- Physical therapy and core strengthening
- Anti-inflammatory medications
- Epidural steroid injections
- Activity modification
When conservative treatment fails or symptoms are severe, minimally invasive surgery like microdiscectomy or endoscopic discectomy can provide relief.
Learn More: Read the complete guide to herniated disc treatment options.
Lumbar Spinal Stenosis
Quick Overview: Spinal stenosis is a narrowing of the spinal canal that puts pressure on the spinal cord and nerves, causing pain, numbness, and weakness—especially when walking or standing.
What Causes Spinal Stenosis?
Stenosis typically develops gradually as part of the aging process:
- Arthritis: Bone spurs and thickened ligaments narrow the canal
- Disc degeneration: Bulging discs take up space
- Facet joint overgrowth: Enlarged joints compress nerves
- Spondylolisthesis: Vertebral slippage narrows the canal
Recognizing the Symptoms
The hallmark symptom is neurogenic claudication—leg pain and weakness that worsens with walking or standing and improves with sitting or bending forward:
- Pain, cramping, or heaviness in both legs
- Numbness or tingling in the legs or feet
- Weakness that limits walking distance
- Relief when sitting, leaning forward, or using a shopping cart
Treatment Approach
Treatment starts conservatively and progresses based on symptom severity:
- Physical therapy: Core strengthening and flexibility
- Medications: Anti-inflammatories and nerve pain medications
- Epidural injections: Reduce inflammation around compressed nerves
- Activity modification: Using assistive devices, pacing activities
When stenosis significantly limits your quality of life, minimally invasive decompression surgery can create more space for the nerves and restore mobility.
Learn More: Explore the full guide to spinal stenosis diagnosis and treatment.
Sciatica
Quick Overview: Sciatica is nerve pain that radiates from the lower back down through the buttock and leg, caused by compression or irritation of the sciatic nerve.
What Causes Sciatica?
Sciatica is a symptom, not a diagnosis. The underlying causes include:
- Herniated disc: Most common cause (90% of cases)
- Spinal stenosis: Narrowing compresses the nerve root
- Spondylolisthesis: Vertebral slippage pinches the nerve
- Piriformis syndrome: Muscle spasm irritates the nerve
Typical Symptoms
- Sharp, shooting pain: From lower back through buttock and down the leg
- Numbness or tingling: Often in the calf, foot, or toes
- Weakness: Difficulty moving the foot or leg
- Pain worsens: With sitting, coughing, or sneezing
Treatment Path
Most sciatica resolves within 6-12 weeks with conservative care:
- Physical therapy focusing on nerve gliding exercises
- Anti-inflammatory medications and muscle relaxants
- Epidural steroid injections for severe pain
- Heat/ice therapy and gentle stretching
If symptoms persist beyond 6-12 weeks or worsen, surgery to remove the disc herniation or decompress the nerve may be recommended. Dr. Greenberg specializes in endoscopic techniques that offer faster recovery.
Learn More: Read the complete sciatica treatment guide.
Spondylolisthesis
Quick Overview: Spondylolisthesis occurs when one vertebra slips forward over the vertebra below it, potentially compressing nerves and causing instability.
Types and Causes
There are several types of spondylolisthesis:
- Degenerative: Most common in adults over 50, caused by arthritis and disc degeneration
- Isthmic: Results from a stress fracture in the vertebra, often from sports in youth
- Congenital: Present from birth due to abnormal bone formation
- Traumatic: Caused by acute injury or fracture
Symptoms to Watch For
- Lower back pain: Worsens with activity, improves with rest
- Leg pain: Similar to sciatica if nerves are compressed
- Tight hamstrings: Difficulty bending forward
- Postural changes: Flattened lower back curve, protruding abdomen
Treatment Options
Treatment depends on the severity of slippage and symptoms:
- Conservative care: Physical therapy, bracing, activity modification
- Medications: Anti-inflammatories and pain management
- Injections: Epidural steroids for nerve pain
- Surgery: When instability or nerve compression is significant
Surgical treatment typically involves decompression to relieve nerve pressure and minimally invasive fusion to stabilize the spine. Dr. Greenberg uses advanced techniques to minimize tissue disruption and speed recovery.
Learn More: Explore the detailed spondylolisthesis guide.
Degenerative Disc Disease
Quick Overview: Despite its name, degenerative disc disease is not really a disease—it's the natural aging process of spinal discs that can sometimes cause pain and other symptoms.
Understanding Disc Degeneration
As we age, spinal discs naturally lose water content and become less flexible:
- Loss of hydration: Discs become thinner and less cushioning
- Tears in the outer layer: Can cause pain and inflammation
- Reduced disc height: Alters spine mechanics and may compress nerves
- Bone spurs: Body's attempt to stabilize the spine
Common Symptoms
- Chronic lower back pain: May be constant or intermittent
- Pain worsens: With sitting, bending, lifting, or twisting
- Pain improves: With walking, changing positions, or lying down
- Occasional flare-ups: Periods of severe pain lasting days to months
Treatment Strategy
Most people with degenerative disc disease manage well without surgery:
- Physical therapy: Core strengthening and flexibility exercises
- Medications: Anti-inflammatories and pain management
- Lifestyle modifications: Weight management, ergonomics, activity pacing
- Injections: Epidural steroids or facet joint injections
Surgery is considered only when conservative treatment fails and pain significantly impacts quality of life. Options include minimally invasive fusion or, in select cases, disc replacement.
Learn More: Read the comprehensive degenerative disc disease guide.
Key Takeaways
- Most lumbar conditions improve with conservative care over 6-12 weeks, including physical therapy, medications, and activity modification.
- Accurate diagnosis is essential—symptoms can overlap, and treatment depends on identifying the specific cause of your pain.
- Surgery is considered when conservative treatment fails, symptoms worsen, or quality of life is significantly impacted.
- Minimally invasive techniques offer faster recovery and less tissue disruption compared to traditional open surgery.
Medical Disclaimer: This chapter provides educational information only and is not intended as personal medical advice. Every patient's condition is unique. Consult with Dr. Greenberg or another qualified spine specialist for an accurate diagnosis and personalized treatment plan.