Back Pain Specialist in Ranchi
Not all back pain is mechanical. When nerves are involved, you need a neurologist. Dr. Yuvraj Lahre (DM Neurology, AIIMS) evaluates and treats back pain with nerve root compression, sciatica, and neurological red flags at Neurovision Clinic, Ranchi.
⚠️ When to Worry
- !Saddle anesthesia (numbness in the inner thighs, buttocks, and perineal region) with new-onset urinary retention or incontinence — this is cauda equina syndrome, a neurosurgical emergency. The cauda equina (bundle of nerve roots below the spinal cord) is compressed, usually by a massive disc herniation. Without decompressive surgery within 24 to 48 hours, permanent paralysis of the legs, loss of bowel and bladder control, and sexual dysfunction can result.
- !Back pain at night that is severe, unrelenting, and not relieved by any position — unlike mechanical back pain which improves with rest and recumbency, nocturnal pain that prevents sleep raises high suspicion for a spinal tumor (primary or metastatic) or spinal infection (vertebral osteomyelitis or epidural abscess).
- !Back pain with unexplained fever, chills, recent bacterial infection, IV drug use, or immunocompromised state — this combination should raise suspicion for a spinal epidural abscess or vertebral osteomyelitis (discitis). Delayed diagnosis can result in permanent paralysis. The classic triad (back pain, fever, neurological deficit) is present in only 15 percent of cases, making a high index of suspicion essential.
- !Progressive bilateral leg weakness with difficulty walking, climbing stairs, or rising from a chair — this indicates significant spinal cord or multiple nerve root compression. If the weakness is rapidly progressive (worsening over hours to days), urgent MRI and neurosurgical consultation are required.
- !Back pain following significant trauma (fall from height, motor vehicle accident, direct blow to the spine) in a patient over 50, or with known osteoporosis — at-risk patients can sustain vertebral compression fractures even from minor trauma like lifting or bending. A CT or MRI is needed to assess spinal stability and rule out retropulsion of fracture fragments into the spinal canal.
- !Back pain in a patient with a known history of cancer (especially breast, lung, prostate, thyroid, renal, or multiple myeloma) — the spine is the most common site for skeletal metastases. Any new or changing back pain in a cancer patient should be considered metastatic disease until proven otherwise.
Possible Causes
Lumbar Disc Herniation with Radiculopathy
The intervertebral disc consists of a tough outer annulus fibrosus and a gel-like nucleus pulposus. When the annulus tears, the nucleus can herniate and compress an exiting nerve root. The L4-L5 and L5-S1 levels account for over 90 percent of symptomatic herniations. The resulting radiculopathy causes sharp, shooting pain, numbness, and tingling in the dermatome of the affected nerve root. L5 radiculopathy causes foot drop and sensory loss over the dorsum of the foot, while S1 radiculopathy causes ankle jerk loss and sensory loss over the lateral foot. Most herniations improve with conservative management.
Lumbar Spinal Stenosis
Age-related degenerative narrowing of the spinal canal or neural foramina, typically due to facet joint hypertrophy, ligamentum flavum thickening, and disc bulging. Unlike disc herniation, spinal stenosis causes neurogenic claudication — leg pain, heaviness, and numbness that comes on with walking or prolonged standing and is relieved by sitting or bending forward (the shopping cart sign). This is because flexion increases the cross-sectional area of the spinal canal. Spinal stenosis typically affects patients over 60 and is a slowly progressive condition.
Spondylolisthesis and Spondylolysis
Spondylolysis is a stress fracture of the pars interarticularis (the bony bridge between the upper and lower facet joints of a vertebra), common in young athletes involved in repetitive hyperextension (gymnasts, cricketers, weightlifters). Spondylolisthesis occurs when a vertebra slips forward over the one below it due to bilateral pars defects (isthmic type) or degenerative facet joint disease (degenerative type). This can cause mechanical back pain with extension and, if the slip is significant, nerve root compression. Grade of slippage is assessed on lateral X-ray or MRI.
Vertebral Compression Fracture
Sudden onset of severe focal back pain after minimal trauma in patients with osteoporosis (postmenopausal women, long-term steroid users, elderly) or pathological fractures from metastatic disease or multiple myeloma. The thoracolumbar junction (T12-L1) is most commonly affected. Multiple compression fractures lead to progressive kyphosis (dowager hump), height loss, and chronic pain. MRI with STIR sequences differentiates acute/edematous fractures from chronic healed ones and helps distinguish osteoporotic from pathological fractures.
Which Specialist Should You See?
For back pain with neurological symptoms (radiating leg pain, numbness, tingling, weakness, or bowel/bladder dysfunction), a neurologist is the appropriate specialist. Dr. Yuvraj Lahre, DM Neurology (AIIMS Bhubaneswar), Gold Medalist, at Neurovision Clinic, Ranchi, has specialized training in localizing spinal and nerve root pathology through detailed neurological examination and electrodiagnostic testing. For pure mechanical low back pain without nerve involvement, a spine orthopedician or physiatrist may be the first point of contact, and Dr. Lahre guides patients to the right specialist when mechanical causes predominate.
Diagnostic Approach
Dr. Lahre begins with the 'surgical sieve' approach to back pain — systematically ruling out the serious causes (fracture, tumor, infection, cauda equina syndrome) before focusing on the more common mechanical and degenerative causes. History includes: pain onset and tempo, exact location and radiation pattern, factors that aggravate and relieve, associated neurological symptoms, systemic symptoms, and cancer risk factors. The neurological examination assesses power (MRC grading), sensation (light touch, pinprick, vibration, proprioception), deep tendon reflexes (knee L4, ankle S1, plantar response), and gait. The straight leg raise test (for L5/S1 root irritation) and femoral stretch test (for L2-L4 root irritation) are performed. MRI is ordered when red flags are present or symptoms persist beyond 4 to 6 weeks. Electrodiagnostic studies (NCS/EMG) complement the imaging by assessing the functional integrity of nerve roots and peripheral nerves.
Experiencing Back Pain?
Don't ignore your symptoms. Get expert evaluation from Dr. Yuvraj Lahre at Neurovision Clinic, Ranchi.