Lumbago is a symptom rather than a disease. In a typical attack of acute lumbago the patient is suddenly seized with agonizing pain in the lumbar region of the spine, usually while stooping, lifting, turning, or coughing. The pain is often so severe that any movement is difficult and the patient is ‘stuck.’ With rest, the pain gradually subsides, but in some cases the acute back pain is succeeded by sciatica, suggesting irritation of a lumbar or sacral nerve.
The pathogenesis of acute lumbago is not entirely clear. Indeed there may be more than one cause. Probably in many cases the underlying lesion is a prolapsed disc that has not yet been retropulsed far enough to interfere with a nerve root. It is in these cases that sciatica may develop later, as the size of the prolapse increases. But other examples of acute lumbago are more convincingly described to some other mechanical disorder, such as sudden nipping of synovial membrane in one of the facet joints, or momentary subluxation with consequent ligamentous strain, especially at an intervertebral joint that is unstable on account of disc degeneration or osteoarthritis. In such a case acute attacks of pain may recur at interval of months or years.
Treatment should usually be to provide rest for the spine, either by recumbency or by a plaster jacket or surgical corset, as for a prolapsed intcrvertebral disc. Full recovery is often observed within one or two weeks. Because of the frightening severity of the pain confident reassurance may be needed.