Low back pain (LBP) is a common clinical problem with major socioeconomic importance. Approximately 70% to 85% of adults are affected by LBP at some point during their lifetime.[4]Andersson GB. Epidemiological features of chronic low back pain. Lancet. 1999 Aug 14;354(9178):581-5.
http://www.ncbi.nlm.nih.gov/pubmed/10470716?tool=bestpractice.com
[5]Carragee EJ, Hannibal M. Diagnostic evaluation of back pain. Orthop Clin North Am. 2004 Jan;35(1):7-16.
http://www.ncbi.nlm.nih.gov/pubmed/15062713?tool=bestpractice.com
Each year, LBP affects approximately one-third of the adult UK population; however, only approximately 20% of people with LBP will consult their doctor about it.[6]Papageorgiou AC, Croft PR, Thomas E, et al. Influence of previous pain experience on the episode incidence of low back pain: results from the South Manchester Back Pain Study. Pain. 1996 Aug;66(2-3):181-5.
https://www.doi.org/10.1016/0304-3959(96)03022-9
http://www.ncbi.nlm.nih.gov/pubmed/8880839?tool=bestpractice.com
[7]Papageorgiou AC, Rigby AS. Review of UK data on the rheumatic diseases--7. Low back pain. Br J Rheumatol. 1991 Jun;30(3):208-10.
https://www.doi.org/10.1093/rheumatology/30.3.208
http://www.ncbi.nlm.nih.gov/pubmed/1828705?tool=bestpractice.com
Although a number of different spinal anatomical structures (facet joints, intervertebral discs, vertebral bodies, ligaments, and muscles), as well as other intra-abdominal or lower thoracic pathological causes, have been identified as possible sources of LBP, the most common cause seems to be a degenerate lumbar intervertebral disc.[8]Deyo RA, Weinstein JN. Low back pain. N Engl J Med. 2001 Feb 1;344(5):363-70.
http://www.ncbi.nlm.nih.gov/pubmed/11172169?tool=bestpractice.com
[9]Mooney V. Where is the lumbar pain coming from? Ann Med. 1989 Oct;21(5):373-9.
http://www.ncbi.nlm.nih.gov/pubmed/2532527?tool=bestpractice.com
[10]Nachemson AL. The lumbar spine an orthopedic challenge. Spine. 1976;1:59-71.[11]Kuslich SD, Ulstrom CL, Michael CJ. The tissue origin of low back pain and sciatica: a report of pain response to tissue stimulation during operations in lumbar spine using local anaesthesia. Orthop Clin North Am. 1991 Apr;22(2):181-7.
http://www.ncbi.nlm.nih.gov/pubmed/1826546?tool=bestpractice.com
[12]Schwarzer AC, Aprill CN, Derby R, et al. The relative contributions of the disc and zygapophyseal joint in chronic low back pain. Spine (Phila Pa 1976). 1994 Apr 1;19(7):801-6.
http://www.ncbi.nlm.nih.gov/pubmed/8202798?tool=bestpractice.com
Radiographic evidence of disc degeneration commences as early as the third decade of life. The changes increase in prevalence and severity with the passage of time by 3% to 4% per annum.[13]Hassett G, Hart DJ, Manek NJ, et al. Risk factors for progression of lumbar spine disc degeneration: the Chingford study. Arthritis Rheum. 2003 Nov;48(11):3112-7.
http://onlinelibrary.wiley.com/doi/10.1002/art.11321/full
http://www.ncbi.nlm.nih.gov/pubmed/14613273?tool=bestpractice.com
[14]Hangai M, Kaneoka K, Kuno S, et al. Factors associated with lumbar intervertebral disc degeneration in the elderly. Spine J. 2008 Sep-Oct;8(5):732-40.
http://www.ncbi.nlm.nih.gov/pubmed/18037353?tool=bestpractice.com
However, there is no clear correlation between symptoms and radiological findings.