There can be many causes of back pain including accidents, strains, and injuries. Two types of back injury are spondylolisthesis and cervical radiculopathy. Both have their own set of symptoms, causes, and treatments.
The spine, or backbone, is made up of a column of 33 bones and tissue extending from the skull to the pelvis. These bones, or vertebrae, enclose and protect a cylinder of nerve tissues known as the spinal cord. Between each one of the vertebra is an intervertebral disk, or band of cartilage serving as a shock absorber between the vertebrae. The types of vertebrae are:
- Cervical vertebrae: the seven vertebrae forming the upper part of the spine
- Thoracic vertebrae: the 12 bones between the neck and the lower back
- Lumbar vertebrae: the five largest and strongest vertebrae located in the lower back between the chest and hips
- The sacrum and coccyx are the bones at the base of the spine. The sacrum is made up of five vertebrae fused together, while the coccyx (tailbone) is formed from four fused vertebrae.
What Causes Back Pain?
The causes of back pain can be complex. Some causes of back pain include accidents, muscle strains, and sports injuries.
What Causes Lower Back Pain?
Back pain is a symptom. Pain arising from other organs may be felt in the back. This is called referred pain.
Many intra-abdominal disorders, such as appendicitis, aneurysms, kidney diseases, bladder infections, pelvic infections, and ovarian disorders, among others, can cause pain referred to the back. Your doctor will have this in mind when evaluating your pain.
- Nerve root syndromes are those that produce symptoms of nerve impingement (a nerve is touched), often due to a herniation (or bulging) of the disc between the lower back bones. Sciatica is an example of nerve root impingement. Impingement pain tends to be sharp, in one spot, and associated with numbness in the area of the leg that the affected nerve supplies.
- Herniated discs are produced as the spinal discs degenerate or grow thinner. The jellylike central portion of the disc bulges out of the central cavity and pushes against a nerve root. Intervertebral discs begin to degenerate by the third decade of life. Herniated discs are found in a third of adults older than 20. Only 3% of these, however, produce symptoms of nerve impingement.
- Spinal stenosis occurs as intervertebral discs lose moisture and volume with age, which decreases the disc spaces. Even minor trauma under these circumstances can cause inflammation and nerve root impingement, which can produce classic sciatica without disc rupture.
- Spinal degeneration is caused by alterations in the disc that progress to degeneration. This, coupled with disease in joints of the low back, causes spinal canal narrowing. These changes in the disc and the joints produce symptoms and can be seen on an x-ray. A person with spinal degeneration may have morning stiffness or pain while standing for a long time or walking even short distances.
- Cauda equina syndrome is a medical emergency. Disc material expands into the spinal canal, which compresses the nerves. A person would experience pain, possible loss of sensation, and bowel or bladder dysfunction. This could include inability to control urination causing incontinence, or the inability to begin urination.
- Musculoskeletal pain syndromes that produce low back pain include myofascial pain syndromes and fibromyalgia.
- Myofascial pain is characterized by pain and tenderness over localized areas (trigger points), loss of range of motion in the involved muscle groups, and pain radiating in a characteristic distribution but restricted to a peripheral nerve. Relief of pain is often reported when the involved muscle group is stretched.
- Fibromyalgia results in pain and tenderness on 11 of 18 trigger points when touched, one of which is the low back area, as classified by the American College of Rheumatology. Generalized stiffness, fatigue, and muscle ache are reported.
- Other skeletal causes of low back pain include osteomyelitis or sacroiliitis (infections of the bones of the spine). This pain is usually worse at night and is worse when sitting or standing for a long time.
- Tumors, possibly cancerous, can be a source of skeletal pain.
How to Treat Back Pain?
There are many ways to treat back pain including things like massage, surgery, prescription drugs and even yoga!
How Is Back Pain Diagnosed?
In addition to performing a complete history and physical exam, your doctor may suggest one of the following diagnostic studies:
- X-rays, which can be used to provide detail of the bone structures in the spine and to check for instability (such as spondylolisthesis, see below), tumors and fractures.
- CT scans, which can identify specific conditions, such as a herniated disc or spinal stenosis.
- MRI scans, which can provide details about the backs discs and nerve roots. MRI scans are most commonly used for pre-surgical planning.
- CT scans, which can identify specific conditions, such as a herniated disc or spinal stenosis.
A number of other imaging and electrical studies may also be used to identify back problems, and some injections are used for diagnostic purposes as well as for pain relief.
Types of Back Injury
- Spondylolisthesis: This is a slipping of vertebra that occurs, in most cases, at the base of the spine. Spondylolysis, which is a defect or facture of one or both wing-shaped parts of a vertebra, can result in vertebrae slipping backward, forward, or over a bone below.
- Cervical Radiculopathy: Cervical radiculopathy is the damage or disturbance of nerve function that results if one of the nerve roots near the cervical vertebrae is compressed. Damage to nerve roots in the cervical area can cause pain and the loss of sensation in various upper extremities, depending on where the damaged roots are located.
Causes of Spondylolithesis
There are many causes for spondylolithesis. A vertebra might be defective from the time a person is born, or a vertebra may be broken by trauma or a stress fracture. In addition, vertebrae can be broken down by infection or disease. Most commonly, this disorder occurs in children and adolescents who are active in athletics.
Symptoms of Spondylolithesis
- Lower back pain
- Muscle tightness and stiffness
- Pain in the buttocks
- Pain radiating down the legs (due to pressure on nerve roots)
Spondylolisthesis is treated with the strengthening of supportive abdominal and back muscles through physical therapy. For patients who continue to have severe pain and disability after physical therapy, there is the option of surgical fusion (arthrodesis) of the vertebra to the bone below.
Causes of Cervical Radiculopathy
Damage can occur as a result of pressure from material from a ruptured disc, degenerative changes in bones, arthritis, or other injuries that put pressure on the nerve roots. In older people, normal degenerative changes in the discs can cause pressure on nerve roots. In younger people, cervical radiculopathy tends to be the result of a ruptured disc. This disc material then compresses the nerve root, causing pain.
Symptoms of Cervical Radiculopathy
The main symptom of cervical radiculopathy is pain that spreads into the arm, neck, chest, and/or shoulders. A person with radiculopathy may experience muscle weakness and/or numbness or tingling in fingers or hands. Other symptoms may include lack of coordination, especially in the hands.
Treatments of Cervical Radiculopathy
Cervical radiculopathy may be treated with a combination of pain medications such as corticosteroids (powerful anti-inflammatory drugs) or non-steroidal pain medication (Motrin or Aleve) and physical therapy. Steroids may be prescribed either orally or injected epidurally (into the dura, which is the membrane that surrounds the spinal cord).
Physical therapy might include gentle cervical traction and mobilization, exercises, and other modalities to reduce pain.
If significant compression on the nerve exists to the extent that motor weakness results, surgery may be necessary to relieve the pressure.
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