Lumbar trauma is very common; however, it rarely involves the bones. Soft tissue injury to the low back is seen in low level trauma and involves things like falls, violence and workplace injuries. High level trauma is more severe and is seen more with automobile accidents and sports injuries. High energy injuries like car accidents and sports accidents are more likely to lead to bony fractures and the need for lumbar fusion. Low energy injuries are likely to injure muscles and ligaments but spare bones. People with osteoporosis have thin, brittle bones and are more likely to sustain a bony injury in even low impact injuries.
Lumbar injuries are divided into the various parts that are injured in the back, such as:
- Disc injuries (herniations)
- Muscle injuries (strains)
- Ligaments (sprains)
- Bones (fractures)
- Levels (L1 to L5)
Fractures can be simple compression fractures, fracture dislocations or burst fractures that damage the vertebral disc. Fracture dislocations are more likely to need to be treated with a spinal fusion as it means that ligaments have been disrupted and a fusion is needed to take care of the ligament that has been damaged. In some cases, it is obvious that surgery is necessary because a brace fails to provide stability for the fracture or because the spine keeps collapsing. In such cases, surgical correction is necessary.
In some cases, chronic arthritis makes the spine painful when moved so that lumbar fusion is necessary to create a situation where the bones do not move at all to lessen pain following the surgery. Patients with cauda equina syndrome have constriction of the very distal part of the spinal cord, where the last several spinal nerves hang down in the spinal canal. If these nerve roots are constricted, surgery is necessary to keep the vertebra from moving against one another.
Strains are painful but often helped by a period of rest, ice and gradual return to normal activity. Sometimes chiropractic treatments help to ease the pain and increase activity. Physical therapy sometimes helps, too. It can take several weeks to regain mobility and relieve pain from strain injuries.