Lumbar Spine Disorders

Low back pain is one of the leading causes of disability worldwide, affecting roughly 80% of people at some point in their lives. The lumbar spine — the five vertebrae of the lower back — bears the majority of the body's weight and is subject to significant mechanical stress from daily activities, bending, lifting, and prolonged sitting. When pain, injury, or degeneration affects this region, it can interfere profoundly with work, recreation, and quality of life.

Dr. Ryan Snowden is a fellowship-trained spine surgeon at Tennessee Orthopedic Alliance, serving patients from Nashville, Mt. Juliet, Franklin, and surrounding Middle Tennessee communities. He specializes in the full spectrum of lumbar spine care, with a strong emphasis on identifying the specific pain generator and matching each patient to the most appropriate treatment — whether that is physical therapy, an injection, or a surgical procedure.

Low Back Pain

Low back pain is rarely one thing — it can arise from muscles and ligaments, the discs between vertebrae, the facet joints, or the nerves that exit the spinal canal. Acute low back pain from a muscle strain or minor injury typically resolves within a few weeks with rest, activity modification, and anti-inflammatory medication. Chronic low back pain lasting more than 12 weeks requires a more thorough evaluation to identify the underlying cause and guide appropriate treatment.

Dr. Snowden takes a structured, evidence-based approach to evaluating low back pain. Most patients are first managed with physical therapy, home exercise programs, and non-prescription or prescription anti-inflammatories. When these are insufficient, targeted injections — such as epidural steroid injections or facet joint blocks — can provide meaningful relief and help clarify the source of pain.

A lumbar disc herniation occurs when the soft inner material of a spinal disc pushes through the outer fibrous ring and presses against a nearby nerve root. This is one of the most common causes of sciatica — the radiating pain that travels from the lower back through the buttock and down the leg, often into the foot. Patients typically describe the pain as sharp, burning, or electric in nature, and it may be accompanied by numbness, tingling, or leg weakness.

The majority of lumbar disc herniations improve with non-surgical treatment over 6 to 12 weeks. When symptoms are severe, involve significant weakness, or do not improve with conservative care, a lumbar microdiscectomy is a highly effective minimally invasive procedure that relieves nerve compression with a short recovery time.

Lumbar spinal stenosis is a narrowing of the spinal canal that puts pressure on the nerves traveling down to the legs. It is most common in patients over 50 and is typically caused by a combination of degenerative disc disease, thickening of the spinal ligaments, and bone spur formation. The hallmark symptom is neurogenic claudication — pain, cramping, or weakness in the legs that worsens with standing or walking and is relieved by sitting or bending forward.

Treatment options range from physical therapy and epidural steroid injections to surgical decompression. Lumbar decompression (laminectomy) removes the bone and tissue compressing the nerves and is one of the most effective and durable surgical treatments for spinal stenosis. In cases where instability is also present, a fusion procedure may be combined with decompression. 

Spondylolisthesis occurs when one vertebra slips forward relative to the vertebra below it. This can result from a stress fracture in the back of the vertebra (isthmic spondylolisthesis, more common in younger patients and athletes) or from degenerative disc and facet joint disease (degenerative spondylolisthesis, more common in adults over 50). Symptoms depend on the degree of slip and may include low back pain, tightness in the hamstrings, and nerve symptoms in the legs.

Mild cases are often managed non-surgically. When slippage is significant or symptoms are disabling, surgical stabilization through a lumbar fusion procedure — such as TLIF, ALIF, or OLIF — restores alignment and eliminates the abnormal motion that is causing pain. 

Degenerative disc disease is not a single disease but rather a natural process of aging in which the intervertebral discs lose water content, height, and elasticity over time. In some patients this process is accelerated or asymmetric and leads to chronic pain. The condition can cause localized axial back pain as well as referred pain into the hips or buttocks. In more advanced cases it can contribute to disc herniation, stenosis, or instability.

Treatment depends on the severity of symptoms and the number of levels affected. Mild to moderate degenerative disc disease is typically managed conservatively. For patients with persistent, disabling discogenic pain, lumbar disc replacement (motion-preserving) or lumbar fusion (stabilizing) may be appropriate surgical options.

Most low back pain does not require surgery — but some conditions do warrant timely specialist evaluation. See a spine surgeon if you have:

• Back pain with leg pain, numbness, or weakness that does not improve after 6 weeks of conservative treatment

• Progressive leg weakness or loss of function

• Bowel or bladder dysfunction associated with back or leg symptoms (seek emergency care)

• Pain that severely limits your ability to walk, stand, or perform daily activities

• Back pain following trauma, or associated with unexplained weight loss or fever

Dr. Snowden offers a comprehensive range of lumbar spine treatments. Surgical procedures include lumbar microdiscectomy, lumbar decompression (laminectomy), and fusion procedures including TLIF, ALIF, and OLIF, as well as lumbar disc replacement for appropriate candidates. Robotic-assisted technology is available to enhance precision in instrumented procedures.