Newest knowledge of low back pain. A critical look.

Scientific scrutiny of the low back problem demonstrates its socioeconomic importance in most industrialized societies. Natural history studies reveal that the prognosis for the low back pain patient is excellent; for those with sciatica and painful spondylolisthesis it is good. It is even relatively good for those older patients with symptoms of spinal stenosis. Although today there is a better understanding of pain, the pathomechanism of low back pain is unknown. However, for patients with sciatica, spondylolisthesis, and spinal stenosis, physicians are beginning to get a better perception of what causes the pain. Psychosocial factors, including insurance benefits, have been demonstrated to be more important than biomechanical workload not only for acute but also for chronic low back pain patients who are unable to work. Orthopedic surgeons must recognize this fact when contemplating operations for patients with ill-defined back syndromes. Rarely are diagnoses scientifically valid, nor is the effectiveness of surgery proven by acceptable clinical trials.