[Musculo-skeletal mechanisms of low back pain]

Authors presented in comprehensive form updated knowledge concerning reasons and mechanisms of musculoskeletal back pain nonspecific symptom which in majority of cases, provides only little inside into the nature of the underlying problem. The physician must however find sufficient time to educate the patient as to the nature of this disorder and likely course during treatment. Understanding the source and mechanisms of the patients pain allows the physician and patient to approach the problem rationally with mutual confidence. The basic aim of the physician is exact identification of the anatomic source of pain and exclude the possibility of underlying systemic or malignant process that might threaten the patient's life. The musculoskeletal system consists of the bones and articulations, ligaments, muscles and tendons, that connect and manipulate them within spinal column. All of these tissues are richly innervated and specific biomechanical conditions cause, that lumbar part of the spine and lumbosacral junction are extremely susceptible to direct and indirect affected by a spectrum of reasons causing pain. The pathomechanism of the pain originating within the facet joints, bone and periosteum, paraspinous muscles and tendons, intervertebral disks, posterior longitudinal ligament and dorsal root ganglion was discussed. Although in majority of causes it possible to control localized pain by means of conservative treatment, however in some patients (0.5%-1%) surgery is needed to decompress neurologic structures, restore stability, and eliminate pain.