Lumbago or low back pain and radiologist Jalal Jalal ShokouhiRadiologist: ISR,Tehran, Iran M.H.Herischi Orthopedic surgeon: Baku,Republic Azarbayjan A.Norousi Neurosureon,Leopold clinic: Munich, Germany H.Mirbagheri Ankle orthopedic surgeon: London U.K. Shahyar PashaeAnatomist: Tehran University, Iran

80% of population experience L.B.P at some point of their life

Prevalence in USA is 18% annual incidence is % Male=Female

Self-limiting with 50% in 2 weeks, 90% by 6 weeks, 1% chronically disabled

Costs are 20 billion US Dollar to 50 billion annually. 10% of patients use 85-90% of the costs

Lumbar strenght: 20% Bony spine, disc and lig. 80% Muscles

Ethiology 1.Disc herniation 2.V-body disease 3.Functional spinal unit disease “F.S.U” or motion segment (Two V-bodies and disc between) Three-Joint Complex = Disc + Facet Joints +(Vessels,Nerves,Muscle and Ligaments) 4.Facet disease 5.Spina bifida 6.Malalignment 7.Spondylolysthesis 8.Spondylitis 9.Spondylodiscitis 10.TB, Brucellosis 11.Pelvic infection 12.Ankylosing spondylitis 13.Aortic aneurysm 14.Pancreas adenocarcinoma 15.Rectal carcinoma 16.Peptic ulcer 17.Spondylosis 18.Lumbar canal stenosis 19.Primary bone tumor 20.Myelomatosis 21.Metastasis 22.Osteoporosis 23.Osteomalatia 24.Retroverted uterus 25.Prostate disease, BPH 26.Urologic and Genital problems. 27.Ankle problems

Radiologist As a radiologist, in diagnosis As an interventional radiologist, in treatment As a patient in general population, ”hard working, bad sitting and no sporting”

Disk herniation 17% under 40 years old 22 % between 40 to 59 years old 36 % those older than 60 years old

Imaging studies 1.Rest 2.Radiography”if symptoms do not resolve by rest, specially age above 50” 3.MRI 4.MRI with GD in operated or tumoral cases. 5.CT with and without contrast 6.Myelography or CT-myelography 7.Diskography

TREATMENT 1.Rest 2.Physiotherapy 3.Neurosurgical and orthopedic “Medical- Surgical” 4.Interventional, less invasive 5.Non-invasive “Facet therapy, periradicular therapy, Neucleotomy” 6.Back school