Perspective on low back pain.

Low back pain is a common and expensive ailment among the working population. Despite the increasing amount of basic and clinical knowledge on low back pain, the precise causes of almost all cases cannot yet be defined. The tissues that could be the sources of pain in the low back have been better identified. The validity of the commonly used diagnosis of facet syndrome is now being questioned, and a favorable response to injection of the facet joints should not be considered an indication for posterior lumbar fusion. Studies continue to indicate that total body vibration and cigarette smoking have a relationship to disk degeneration. Improved imaging techniques such as computed tomography and magnetic resonance imaging allow better visualization of the pathology in the vertebral column, but the correlation between these imaging findings and clinical symptoms has yet to be proven. Psychosocial factors are now recognized as important in patients with low back pain. Surgical procedures, even when appropriately indicated, have produced no better result than has the natural course of the condition.