Back Pain

Back pain is pain felt in the back that usually originates from the muscles, nerves, bones, joints or other structures in the spine.

The pain can often be divided into neck pain, upper back pain, lower back pain or tailbone pain. It may have a sudden onset or can be a chronic pain; it can be constant or intermittent, stay in one place or radiate to other areas. It may be a dull ache, or a sharp or piercing or burning sensation. The pain may be in the upper back, and might radiate into the arm and hand or or in the lower back, and might radiate into the leg or foot. Back pain may be accompanied by other symptoms other than pain, such as weakness, numbness or tingling.

Back pain is one of humanity’s most frequent complaints. In the U.S., acute low back pain is the fifth most common reason for physician visits. About nine out of ten adults experience back pain at some point in their life, and five out of ten working adults have back pain every year. The spine is a complex interconnecting network of nerves, joints, muscles, tendons and ligaments, and all are capable of producing pain. Large nerves that originate in the spine and go to the legs and arms can make pain radiate to the extremities.

Bone Spurs

Bone spurs, also known as Osteophytes, are bony projections that usually form along joints. Bone spurs form due to the increase in a damaged joint’s surface area. Most commonly it happens from the onset of arthritis. Bone spurs usually limit joint movement and typically cause pain.

Bone spurs grow naturally on the back of the spine as a person ages and are a sign of degeneration in the spine. In this case the spurs are not the source of back pains, but instead are the common symptom of a deeper problem. However, bone spurs on the spine can impinge on nerves that leave the spine for other parts of the body. This impingement can cause pain in both upper and lower limbs and a numbness or tingling sensations in the hands and feet due to the nerves supplying sensation to their dermatomes.

Spurs can also appear on the feet, either along toes or the heel, as well as on the hands. In extreme cases bone spurs have grown along a person’s entire skeletal structure: along the knees, hips, shoulders, ribs, arms and ankles.

Osteophytes on the fingers or toes are known as Heberden’s nodes (if on the DIP joint) or Bouchard’s nodes (if on the PIP joints).

Bone spurs may also be the end result of certain disease processes, such as osteomyelitis, charcot foot and some others.

Bulging Disc

A spinal disc herniation (prolapsus disci intervertebralis), informally and misleadingly called a “slipped disc”, is a medical condition affecting the spine, in which a tear in the outer, fibrous ring (annulus fibrosus) of an intervertebral disc (discus intervertebralis) allows the soft, central portion (nucleus pulposus) to bulge out. Tears are almost always posterior-ipsilateral in nature owing to the presence of the posterior longitudinal ligament in the spinal canal. This tear in the disc ring may result in the release of inflammatory chemical mediators which may directly cause severe pain, even in the absence of nerve root compression. This is the rationale for the use of anti-inflammatory treatments for pain associated with disc herniation, protrusion, bulge, or disc tear.

It is normally a further development of a previously existing disc protrusion, a condition in which the outermost layers of the annulus fibrosus are still intact, but can bulge when the disc is under pressure.

Degenerative Disc Disease

Degeneration of the intervertebral disc, often called “degenerative disc disease” (DDD) of the spine, is a condition that can be painful and can greatly affect the quality of one’s life. While disc degeneration is a normal part of aging and for most people is not a problem, for certain individuals a degenerated disc can cause severe constant chronic pain.

With symptomatic degenerative disc disease, chronic low back pain sometimes radiates to the hips, or there is pain in the buttocks or thighs while walking; sporadic tingling or weakness through the knees may also be evident. Similar pain may be felt or may increase while sitting, bending, lifting, and twisting. Chronic neck pain can also be caused in the upper spine, with pain radiating to the shoulders, arms and hands.

Failed Back Surgery Syndrome

Failed back syndrome or post-laminectomy syndrome is a condition characterized by persistent pain following back surgeries.

Failed back syndrome (FBS), also called “failed back surgery syndrome” (FBSS), refers to chronic back and/or leg pain that occurs after back (spinal) surgery. It is characterized as a chronic pain syndrome. Multiple factors can contribute to the onset or development of FBS. Contributing factors include but are not limited to residual or recurrent disc herniation, persistent post-operative pressure on a spinal nerve, altered joint mobility, joint hypermobility with instability, scar tissue (fibrosis), depression, anxiety, sleeplessness and spinal muscular deconditioning. An individual may be predisposed to the development of FBS due to systemic disorders such as diabetes, autoimmune disease and peripheral blood vessels (vascular) disease. Smoking is a risk for poor recovery.

Common symptoms associated with FBS include diffuse, dull and aching pain involving the back and/or legs. Abnormal sensibility may include sharp, pricking, and stabbing pain in the extremities. The term “post-laminectomy syndrome” is used by some doctors to indicate the same condition as failed back syndrome.

The treatments of post-laminectomy syndrome include physical therapy, minor nerve blocks, transcutaneous electrical nerve stimulation (TENS), behavioral medicine, non-steroidal anti-inflammatory (NSAID) medications, membrane stabilizers, antidepressants, spinal cord stimulation, and intracathecal morphine pump. Use of epidural steroid injections may be minimally helpful in some cases. The targeted anatomic use of a potent anti-inflammatory anti-TNF therapeutics is being investigated.

The amount of spinal surgery varies around the world. The most is performed in the United States and Holland. The least in the United Kingdom and Sweden. Recently, there have been calls for more aggressive surgical treatment in Europe (see infra). Success rates of spinal surgery vary for many reasons.

Treatment – It depends on the cause. If there is nerve root compression, then we can treat it directly. If there is just scarring, then it is treatable with pain management

Herniated Disc

A spinal disc herniation (prolapsus disci intervertebralis), informally called a “slipped disc”, is a medical condition affecting the spine, in which a tear in the outer, fibrous ring (annulus fibrosus) of an intervertebral disc (discus intervertebralis) allows the soft, central portion (nucleus pulposus) to bulge out. Tears are frequently posterior-ipsilateral in nature owing to the presence of the posterior longitudinal ligament in the spinal canal. It is normally a further development of a previously existing disc protrusion.

Pinched Nerve

Radiculopathy is not a specific condition, but rather a description of a problem in which one or more nerves are affected and do not work properly (a neuropathy). The emphasis is on the nerve root. This can result in pain (radicular pain), weakness, numbness, or difficulty controlling specific muscles.

In a radiculopathy, the problem is at or near the root of the nerve, along the spine. However, the pain or other symptoms may manifest in an extremity through a process called referred pain. For example, a nerve root impingement in the neck can produce pain and weakness in the forearm. Likewise, an impingement in the lower back or lumbar-sacral spine can be manifested with symptoms in the foot. Polyradiculopathy is the name of the term for describing when more than one spinal nerve roots are affected.

Prolapsed Disc

A spinal disc herniation (prolapsus disci intervertebralis), informally and misleadingly called a “slipped disc”, is a medical condition affecting the spine, in which a tear in the outer, fibrous ring (annulus fibrosus) of an intervertebral disc (discus intervertebralis) allows the soft, central portion (nucleus pulposus) to bulge out. Tears are almost always posterior-ipsilateral in nature owing to the presence of the posterior longitudinal ligament in the spinal canal. This tear in the disc ring may result in the release of inflammatory chemical mediators which may directly cause severe pain, even in the absence of nerve root compression. This is the rationale for the use of anti-inflammatory treatments for pain associated with disc herniation, protrusion, bulge, or disc tear.

It is normally a further development of a previously existing disc protrusion, a condition in which the outermost layers of the annulus fibrosus are still intact, but can bulge when the disc is under pressure.

Radiculopathy

Radiculopathy is not a specific condition, but rather a description of a problem in which one or more nerves are affected and do not work properly (a neuropathy). The emphasis is on the nerve root. This can result in pain (radicular pain), weakness, numbness, or difficulty controlling specific muscles.

In a radiculopathy, the problem is at or near the root of the nerve, along the spine. However, the pain or other symptoms may manifest in an extremity through a process called referred pain. For example, a nerve root impingement in the neck can produce pain and weakness in the forearm. Likewise, an impingement in the lower back or lumbar-sacral spine can be manifested with symptoms in the foot. Polyradiculopathy is the name of the term for describing when more than one spinal nerve roots are affected.

Slipped Disc

A spinal disc herniation (prolapsus disci intervertebralis), informally and misleadingly called a “slipped disc”, is a medical condition affecting the spine, in which a tear in the outer, fibrous ring (annulus fibrosus) of an intervertebral disc (discus intervertebralis) allows the soft, central portion (nucleus pulposus) to bulge out. This tear in the disc ring may result in the release of inflammatory chemical mediators which may directly cause severe pain, even in the absence of nerve root compression. This is the rationale for the use of anti-inflammatory treatments for pain associated with disc herniation, protrusion, bulge, or disc tear.

It is normally a further development of a previously existing disc protrusion, a condition in which the outermost layers of the annulus fibrosis are still intact, but can bulge when the disc is under pressure.

Sciatica

Sciatica (or sciatic neuritis) is a set of symptoms including pain that may be caused by general compression and/or irritation of one of five spinal nerve roots that give rise to each sciatic nerve, or by compression or irritation of the left or right or both sciatic nerves. The pain is felt in the lower back, buttock, and/or various parts of the leg and foot. In addition to pain, which is sometimes severe, there may be numbness, muscular weakness, pins and needles or tingling and difficulty in moving or controlling the leg. Typically, the symptoms are only felt on one side of the body.

Although sciatica is a relatively common form of low back pain and leg pain, the true meaning of the term is often misunderstood. Sciatica is a set of symptoms rather than a diagnosis for what is irritating the root of the nerve, causing the pain. This point is important, because treatment for sciatica or sciatic symptoms will often be different, depending upon the underlying cause of the symptoms.

Spinal Stenosis

Word stenosis means narrowing. Stenosis means narrowing of the blood vessels. The same as vascular. Spinal stenosis means the main spinal canal is narrowed.

The term Spinal Stenosis does not reflect, which element of the spinal structures causes this narrowing. Many times bone growth creates it, something ligament tissue growth provides for it.

Most of the spinal Spinal stenosis cases, though, ave due to a significant disc bulge, prolapse, herniation or any other disk component which causes the symptoms. Any of these disk components are treatable which our non-traumatic access approach.

Spondylolisthesis

Spondylolisthesis describes the anterior displacement of a vertebra or the vertebral column in relation to the vertebrae below. These “slips” occur most commonly in the lumbar spine.

Usually this condition is found on the films, especially flexion-extension X-rays. On these films it is easy to see that shift our relative to another when the person changes position.

A hangman’s fracture is a specific type of spondylolisthesis where the C1 vertebra is displaced anteriorly relative to the C2 vertebra due to fractures of the C2 vertebra’s pedicles.This condition usually does not need treatment. In very severe cases when the movement of the spine impinges on the nerves roots, fusion is recommended to stabilize the spine.