Backache and
Low Back Pain
Dr Paul Thng Leong Keng 
MBBS (Singapore)
FRCS (Edin)
FRCS (Glas)
Introduction
Backache/low back pain is one of the most common conditions of mankind. A study from the USA revealed that 80% of the population would consult a doctor at least once in his or her lifetime for backache.
Components of the lumbar
Origin of backache / low back pain
Backache most commonly originates from one or more structures of the spine (see diagram above). It may commonly arise from:
- Back musculature
- The intervertebral disc (degenerative or slipped)
- The facet joints
- Ligaments
- Nerve compression
- Spinal instability
- Others
In addition, backache/low back pain occasionally arises from structures out of the spine, including retroperitoneal (at the back of the abdomen) structures
Diagnosis of backache/low back pain
An accurate medical history and physical examination would help localize the cause of backache/low back pain. Additional tests would help further define the problem. Usually X-rays and Magnetic Reasonance Imaging (MRI) can help provide various images of the spine. Other radiological investigations like the computerized tomography (CT) scan or bone scans may be required in certain circumstances. Occasionally some other tests might be needed e.g. HLAB27 for ankylosing spondylitis.
Some common causes of backache/low back pain include:
- Prolapsed or degenerate disc disease “slipped disc”
- Spinal stenosis
- Spondylolithesis
- Spondylosis
- Facet arthritis
- Spinal instability
- Spinal infections and tumours
- Others causes like curved spines (scoliosis or kyphosis)
The above conditions can also sometimes lead to spinal nerve compression, giving accompanying symptoms of pain, numbness and or weakness in the lower limbs. Often this might be brought on by walking (neurogenic claudication) and relieved by resting or sitting down. Sometimes the pain might be sharp and unbearable (sciatica)
Treatment of backache / low back pain
Treatment of backache would involve understanding the cause of backache/low back pain, identifying the pathology and successful treating the cause and if possible controlling and reversing the pathology concerned.
Options include
Non-invasive modalities including:
- Medication
- Physiotherapy
- Exercise
- Yoga
- Chiropractic Treatments
- Acupuncture
- Back Manipulations
Spinal injections may often be diagnostic and therapeutic in nature.
Surgical intervention of various forms (minimally invasive or open) can be considered if non-invasive methods fail or if there are indications for surgery (e.g. progressive nerve compression).
Example of a patient presenting with back pain with some leg pain. MRI on the left shows 2 level degenerative disc disease with annular tears. The patient responded to physical therapy and medication.
Dr Paul Thng Leong Keng
Dr. Thng has been recognized for his work internationally and has been invited to demonstrate live spine surgical and operative skills in several countries.
- Senior Consultant and Medical Director, PTL Spine & Orthopaedics Clinic
- Visiting Senior Consultant Orthopaedic Surgeon, Changi General Hospital
- Adjunct Associate Professor, National University Hospital
- Trustee, AO Foundation
- Associate Editor, Global Spine Journal
- Scientific Reviewer, Singapore Medical Journal and Annuals of the Academy
Dr Paul Thng Leong Keng is a fellowship-trained orthopaedic surgeon subspecializing in spinal surgery. Based on hospital OTM records from 2003-2013, he performed over 3000 operations and over 1200 spine procedures, both open and minimally invasive. He has held various prestigious positions such as the Head of Spine service at Changi General Hospital, Chairman of AOSpine East Asia, and Executive Member of AOSpine International Board.
Dr. Thng has been recognized for his work internationally and has been invited to demonstrate live spine surgical and operative skills in several countries. He continues to contribute to the field through research and serves as an associate editor of the Global Spine Journal.
PTL Spine & Orthopaedics
Mount Elizabeth Novena Specialist Centre
38 Irrawaddy Road #07-34
Singapore 329563
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