Lower Back Pain (Lumbar Spine)

Lower back pain is the most common reason adults see a spine specialist. Most cases have a specific structural cause, and most can be treated without surgery if identified correctly and early.

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Neurosurgeon

15+ Years

Experience

5000+

Procedures Performed

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What Is Lower Back Pain (Lumbar Spine)

The lumbar spine (L1–L5) bears the majority of the body's load and allows the greatest range of motion of any spinal region. This combination makes it highly susceptible to both acute injury and cumulative degeneration. The sacrum and sacroiliac (SI) joints—directly below L5—are part of the same functional unit and a significant source of pain that is frequently missed or misattributed to lumbar pathology.

Lumbar pain varies enormously in character. Axial low back pain (centered in the back itself) has different causes and treatments than radicular pain (shooting down the leg). Correctly distinguishing between the two and identifying the exact source is what separates effective treatment from treatment that cycles indefinitely without resolution.

30 Minutes

Same Day Procedure

General Anesthesia

2-6 Weeks Recovery

Common Types of Lower Back Pain (Lumbar Spine) Conditions

Lumbar Herniated Disc

Also called "slipped disc," "ruptured disc," and "disc prolapse."

The most common structural cause of leg pain. The inner disc material (nucleus pulposus) pushes through the outer disc wall and presses on a nerve root, causing sciatica. L4–L5 and L5–S1 are affected in the vast majority of cases. Symptoms follow a predictable dermatomal pattern; the affected level determines where the pain, numbness, or weakness appears in the leg or foot. Most herniations improve with conservative treatment within 6–12 weeks. Persistent or severe symptoms, especially motor weakness, indicate the need for intervention.

Lumbar Spinal Stenosis

Also called "central canal stenosis" and "foraminal stenosis."

Narrowing of the lumbar spinal canal that compresses the nerve bundle (cauda equina) or individual nerve roots. Unlike disc herniation, which tends to cause sharp, acute leg pain, stenosis typically produces neurogenic claudication: leg aching, heaviness, or cramping that builds with walking or standing and relieves with sitting or forward flexion. A common condition in patients over 60, driven by disc degeneration, bone spurs, and ligament thickening. Surgery (laminectomy) has strong evidence for outcomes in patients who have failed conservative management.

Degenerative Disc Disease

Also called "lumbar DDD" and "lumbar spondylosis."

The progressive breakdown of lumbar discs is loss of hydration, disc height, and shock-absorption capacity. DDD is ubiquitous on MRI scans after age 40, but the presence of degeneration on imaging does not equal the source of pain. Clinically significant DDD causes chronic axial low back pain, often worse with prolonged sitting, forward bending, or transitioning from sitting to standing. Secondary effects, bone spur formation, facet arthritis, and foraminal narrowing are frequently the actual pain generators. Treatment targets the specific secondary structure, not the disc itself.

Spondylolisthesis

Also called "lumbar slip," "isthmic," or "degenerative spondylolisthesis"

Forward slippage of one lumbar vertebra over the one below it. In degenerative spondylolisthesis (most common in adults over 50), the slip results from facet joint degeneration. In isthmic spondylolisthesis, a stress fracture of the pars interarticularis, often from adolescent sports, allows the slip. Symptoms include low back pain, leg pain, and, in higher-grade slips, significant neurological compromise. Stable slips with mild symptoms are managed conservatively; unstable or symptomatic slips that have failed conservative treatment are candidates for surgical stabilization and fusion.

Sciatica

Also called "lumbar radiculopathy" and "sciatic nerve pain."

Sciatica is a symptom, not a diagnosis. It describes pain that travels along the path of the sciatic nerve from the lower back through the buttock and down the posterior leg to the foot. It is caused by compression or irritation of one or more lumbar nerve roots, most commonly from a herniated disc, bone spur, or stenosis. The location and character of the leg pain correlate with the affected nerve root level, making it an important diagnostic tool. Treatment targets the underlying cause, not the sciatica itself.

SI Joint Dysfunction

Also called "sacroiliac joint pain" or "sacroiliitis."

The sacroiliac joint connects the sacrum to the ilium of the pelvis. It absorbs load transferred between the spine and the legs. When this joint becomes inflamed or hypermobile, it produces pain in the lower back, buttock, and sometimes the groin or posterior thigh, a pattern that closely mimics lumbar disc or nerve root pain. SI joint dysfunction is responsible for approximately 15–25% of chronic low back pain and is frequently missed because it doesn't show on standard MRI. Confirmed by diagnostic injection; treated with targeted injections, physical therapy, or SI joint fusion in refractory cases.

Common symptoms

Leg pain (sciatica)

Pain, burning, or electric sensation traveling from the lower back through the buttock and into the leg following a nerve root pattern

Leg numbness or tingling

Specific areas of the leg or foot affected depending on which nerve root (L4, L5, S1) is compressed

Leg weakness

Foot drop, difficulty climbing stairs, or weakness in specific leg muscles indicates significant nerve compression

Pain with walking (neurogenic claudication)

Leg cramping or aching that worsens with walking and improves with sitting is a hallmark of lumbar stenosis

Stiffness and limited mobility

Difficulty bending, rising from a chair, or standing straight is common with disc disease and facet arthritis

Groin or buttock pain

May indicate SI joint dysfunction, hip pathology, or high lumbar nerve root involvement often misdiagnosed

How we diagnose lumbar spine conditions

The lumbar spine has multiple potential pain generators at every level. Accurate diagnosis requires matching symptoms to a specific structure — not just treating the most prominent MRI finding.

Clinical examination

Straight leg raise test, neurological assessment of lower extremities, gait analysis, and provocation testing

MRI (lumbar spine)

Primary imaging disc herniations, nerve root compression, stenosis, bone marrow changes

CT scan

Bone detail, foraminal narrowing, facet arthritis, pars defects, surgical planning

Standing X-ray with flexion/extension

Detects instability, spondylolisthesis grade, and alignment under load

Diagnostic nerve block

Targeted injection confirms whether a specific nerve root, facet joint, or SI joint is the actual pain source

EMG / Nerve conduction

Differentiates lumbar radiculopathy from peripheral neuropathy when the diagnosis is unclear

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How we approach lumbar treatment

We follow a structured pathway; the goal is the right treatment, not the most aggressive one.

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Accurate diagnosis

Clinical exam + targeted imaging + diagnostic injection where needed to confirm the pain generator

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Conservative management

Physical therapy, activity modification, and anti-inflammatory treatment for appropriate cases

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Interventional pain management

Epidural injections, facet blocks, RFA, or SI joint injection when conservative care is insufficient

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Surgical evaluation

Offered when conservative measures have failed, neurological function is compromised, or symptoms are severe with full discussion of risks, expected outcomes, and alternatives

Seek urgent evaluation; these symptoms require same-day assessment

Bowel or bladder incontinence or retention

Progressive bilateral leg weakness

Back pain with fever or unexplained weight loss

Saddle area numbness (inner thighs, groin, perianal)

Foot drop

History of cancer with new or worsening back pain

Treatment Options

Lumbar treatment spans a wide range from a single targeted injection to complex multi-level fusion. The diagnosis determines the pathway.

Non-surgical

Lumbar epidural steroid injection

Reduces nerve root inflammation from disc herniation or stenosis — most effective in the acute/subacute phase

Lumbar facet joint injection / medial branch block

Diagnostic and therapeutic for facet-mediated axial back pain

Radiofrequency ablation (RFA)

12–24 months of relief for facet disease disables the nerve that carries pain from the joint

SI joint injection

Diagnosis and treatment of sacroiliac joint pain guided with fluoroscopy or CT

Physical therapy and core rehab

Structured program targeting lumbar stabilizers essential for DDD, spondylolisthesis, and post-surgical rehab

Surgical

Microdiscectomy

Minimally invasive removal of the herniated disc fragment compressing the nerve root. High success rate for sciatica from disc herniation: most patients see significant leg pain relief.

Lumbar laminectomy (decompression)

Surgical removal of the lamina and ligament tissue compressing the nerves is the primary treatment for symptomatic lumbar stenosis

Lumbar spinal fusion

Stabilizes unstable segments indicated for spondylolisthesis, recurrent disc herniation, or deformity. Various approaches (TLIF, ALIF, and PLIF), depending on the anatomy and clinical situation, are used.

SI joint fusion

Minimally invasive stabilization of the SI joint for confirmed refractory SI joint dysfunction that has failed injections and physical therapy

You've probably tried things that haven't worked. Let's find out why.

Most chronic lower back pain has a specific structural source. We'll find it and give you a clear plan.

Request Appointment

(571) 399 6340

What to expect week by week

Recovery varies, but here's how most patients progress.

Same Day

Go home. Rest.

Procedure done. Mild soreness at the injection site is normal. Skip driving — you'll need a ride.

24–48 Hours

Soreness fades.

Site soreness clears in a day or two. Some patients notice early pain improvement starting here.

1 Week

You should feel a difference.

Most patients see a meaningful reduction in neck and arm pain as the steroid reaches full effect.

Weeks–Months

Continued improvement.

Relief can last weeks to months. A second injection or PT can extend it further if needed.

Expert Spine Surgeon

Dr. Avery L. Buchholz is a board-certified neurosurgeon with fellowship training in complex spine surgery. With over 15 years of experience and 5,000+ procedures performed, he specializes in both minimally invasive and complex surgical techniques.

His expertise spans the full spectrum of spine care, from non-surgical interventions to advanced reconstructive procedures, always prioritizing patient safety and optimal outcomes.

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About Dr. Buchholz

Frequently Asked Questions

Get answers to common questions about our practice and procedures

How common is lower back pain?

About 80% of adults experience significant low back pain at some point. It's the leading cause of disability in adults under 45.

Does lower back pain always require surgery?

No — about 90% of cases can be managed without surgery when diagnosed correctly. Surgery is reserved for specific, more severe cases.

When should I see a specialist?

If pain persists beyond 6 weeks, it's time for an evaluation. Earlier evaluation is warranted if you have leg weakness or other red-flag symptoms.

What's the difference between back pain and sciatica?

Axial pain stays in the back itself, while sciatica radiates down the leg. They have different causes and require different treatment approaches.

How is lower back pain diagnosed?

Through a physical exam, MRI or CT imaging, and sometimes a diagnostic nerve block. Matching symptoms to the exact structure involved is key.

What surgical options exist?

Microdiscectomy for disc herniation, laminectomy for stenosis, and fusion for instability or spondylolisthesis. The right option depends on the diagnosis.