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Many people suffer from severe acute LBP after lifting or snapping at several points in their lifetime. Conservative treatments recommend to the patients. But these treatments typically don’t help with severe acute LBP. It requires several weeks for the patients to get the satisfactory recovery For case in which the pain is severe, physicians commonly perform the interventional procedure like as spinal injection therapy including medial branch block (MBB) and epidural block for rapid pain relief. Although widely used, the beneficial effect of spinal injection therapy on the clinical outcome has not been succeeded. We believe that injection therapy should be administered depending on the mechanism of acute LBP. Lumbar flexion posture followed by lifting or snapping could result in the strongest loading to the vertebral segment. The 3-column, which is consisted of vertebral segment, is all influenced by this sudden loading simultaneously (Fig. 1). In this situation, we consider that increased flexion loading causes a change of the intradiscal integrity in the anterior column and this change would be able to be seen on MRI. Inflammation and dural irritation occurs at the middle column around sinuvertebral nerve. Finally, the posterior column shows ligament laxity and back muscle contraction we call the deep somatic derangement. We consider that this 3-column distress is the most important underlying mechanism of severe acute LBP. And we regard ISSN 2466-0167 Asian J Pain 2016;2(1):22-28

asian journal of pain

A Rapid Pain Management and Possible Mechanism of Severe Acute Low Back Pain after Traumatic Event : A Comparative Analysis of Spinal Injection Therapy with Segmental 3-Column Theory