PATIENT INFORMATION

About Back Pain

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Common Symptoms | Causes of Back Pain | Prevention | Anatomy

Common Symptoms

Back pain can be felt constantly or intermittently, and may be dull, sharp, piercing, or a burning sensation. The pain can stay in one place or refer (or radiate) to other areas, such as the front, sides, back, and legs. Low back pain is often associated with radiating leg pain.



Acute pain comes on suddenly, and can be severe, but usually lasts a relatively short time. Chronic pain is a persistent state of pain that does not get better on its own over time. Besides pain, other symptoms are often associated with back pain, such as muscle spasm, stiffness, decreased motion, numbness in the groin, shifted posture, and muscle weakness. Acute pain is more common and many of these symptoms will clear up within a short period of time. If symptoms persist, you should consult your doctor.

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Causes of Back Pain

Muscles
Back pain can be the result of a sudden, awkward movement, strained back muscles and ligaments, or lifting heavy objects or using improper form when lifting objects.

Nerves
Pressure or impingement of nerve roots in the spinal canal can be caused by herniated discs, arthritic conditions, bone spurs, or displacement of vertebrae, and can result in pain throughout all areas of the back, and often into the extremities.

Degenerative Disc Disease (DDD)

DDD is defined simply as the wear and tear of the intervertebral disc, which may represent normal aging or may be due to longstanding trauma. It involves small tears in the annulus and lack of water content of the nucleus. The degenerative cascade can lead to disc bulging, development of bone spurs (or osteophytes), and loss of disc space height and/or alignment, which can cause nerve impingement. DDD can also lead to degenerative instability, the loss of the ability of the spine under physiologic loads to maintain its pattern of normal movement due to disc degeneration.



Disc Herniation

Posterior displacement of disc tissue from the intervertebral disc space produces pressure on the nerve roots or on the contents of the spinal canal. This pressure causes pain down into the legs.



Disc herniations are often treated surgically to relieve nerve compression.

Degenerative Scoliosis

Degenerative scoliosis is a medical condition where a right-left curvature of the spine develops, due to degeneration of the disc. This misalignment of the spine can cause back and/or leg pain, due to muscle fatigue and nerve impingement. Patients suffering from scoliosis often undergo back surgery to restore proper alignment and disc height.



During the procedure, the surgeon removes most of the disc between the two or more vertebrae that are to be stabilized and implants a spacer to restore correct spinal alignment. The surgeon also implants bone-forming cells that bridge the space between the vertebrae and allow the bone to grow together. Increased stability and restoration of alignment often result in significant pain relief.

Spondylolisthesis

From “spondy” meaning spine and “listhesis” meaning to slip, this is a slipped spine or a spinal segment which has slipped over another. This movement can be caused by fracture, by degenerated facet joints which override one another (degenerative spondylolisthesis), or by elongated bones. This condition can also be due to a congenital pars fracture. Spondylolisthesis is graded 1-4 with Grade 1 being the least severe and Grade 4 the most. Grade 1 is usually treated nonoperatively first. However, failure of conservative management may require surgical fusion.



Spinal Stenosis

Stenosis is the narrowing of the canals through which nerves travel. Stenosis may occur in any region of the spine. It may be central, on one side, or on both sides. The narrowing seen in spinal stenosis may be produced by soft tissue changes (such as disc herniation, fibrous scar, or tumor), or it may be the result of bony changes. The reduced volume and altered shape of the canal can lead to compression of nerve elements within the spinal canal and intervertebral spaces.



 

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Prevention

Using proper body mechanics can alleviate pain.

Lifting
Let your legs do the work. Keep your back straight and bend only at the knees. Hold the load close to your body. Avoid lifting and twisting simultaneously or lifting excessive weight.

Sitting
Choose a seat with good lower back support. A chair with armrests helps maintain proper posture, and a swivel base moves with you, preventing twisting that can cause strain. Consider placing a pillow or rolled towel in the small of your back to maintain its normal curve. Keep your knees and hips level.

Sleeping
Recent studies indicate that a medium-firm mattress might be best for those with back pain. Use pillows for support, but don’t use a pillow that forces your neck up at a severe angle.

Standing
Be aware of your posture when standing and maintain a neutral pelvic position. When standing for long periods of time, alternately placing your feet on a low object, such as a footstool, will take some of the load off your lower back.

Exercise

Aerobics
Low-impact aerobic activities put a minimal amount of strain on the back. Aerobics can increase strength and endurance in your back and allow your muscles to function better. Walking and swimming are good choices.

Stretching
Increasing core (abdominal and back) muscle strength is important. When these muscles are strong, they can work together like a natural corset for your back. Flexibility in your hips and upper legs aligns your pelvic bones to improve how your back feels.

Other Considerations

Smoking
If you smoke, quitting can make a difference. Diminished oxygen levels in the spinal tissues of smokers can hinder the healing process.

Weight
Maintain a healthy weight. Being overweight puts strain on your back muscles. If you’re overweight, trimming down can prevent back pain.

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Anatomy

The spinal column is made up of 33 bones called vertebrae that connect to form what is commonly referred to as the backbone. Together, these vertebrae create structure and support for the human body, as well as encircle the spinal cord to provide valuable protection for important spinal nerves. The bones of the spine are connected by intervertebral discs and joints called facet joints. In addition to strength and stability, these joints also ensure a proper amount of flexibility to the spine.

To gain a better understanding of your condition and treatment options, it may be helpful to explain the five specific regions of the spine:

  1. The upper region is called the cervical region and includes the top seven vertebrae of the spine, which make up the bones of the neck.
  2. The next grouping is called the thoracic region and makes up the middle, or chest portion of the spine. These 12 vertebrae are attached to the ribs.
  3. The lumbar region contains the next five vertebrae which are found in the lower back.
  4. The next five vertebrae are fused into one bone called the sacrum.
  5. The final four vertebrae are fused to form the coccyx or tailbone.

Spine Discs (A) Between each spinal bone, or vertebra, is a soft spinal disc that cushions and absorbs shock in the body during loading and bending activities. Each spinal disc is composed of two parts - the tough outer layer called the annulus and the soft interior called the nucleus. As the body ages, the discs naturally lose water, and as a result, they no longer cushion the spine as well as they should. This process, called disc degeneration, often leads to disc herniation, pain, and instability. Trauma or injury to the disc can result in similar problems and symptoms.

Spinal Nerves (B) The spinal cord is a bundle of nerve fibers that act as the main carrier of information between the body and the brain. The spinal cord extends from the base of the brain through the central spinal canal to the lower back, ending in the upper lumbar region. Spinal nerves extend from the spinal canal to carry constant signals to and from the organs, muscles, and tissues of the body.

The nerves in the lower spine control motor function and sensation in your lower back and legs and are commonly associated with spinal problems. These problems include disc space collapse, instability, and malalignment. If any of these lower spinal nerves become impinged, you may experience back, groin, and/or leg pain or numbness.

Spinal Ligaments (C) Spinal ligaments are another important component to the stability of the spine. The ligaments are tough bands of elastic tissue that connect the bones together and help restrain excessive motion at the joints and also stabilize the spine during movement.

Back and Trunk Muscles The final stabilizers of the spine are the muscles that attach to it. Back muscles are called the paraspinal muscles and run up and down the center of, and alongside, the spine. The muscles on the side of the trunk are called the abdominal oblique muscles. Trauma to this group of muscles tends to be less disabling than to the muscles of the center back, making the side a superior point of access to the spine.

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The materials on this Web site are for your general educational information only. Information you read on this Web site cannot replace the relationship that you have with your healthcare professional. We do not practice medicine or provide medical services or advice as a part of this Web site. You should always talk to your healthcare professional for diagnosis and treatment. Please use the Physician Locator on www.lateralaccess.org to find a SOLAS™ surgeon in your area.

Nate “Rock” Quarry is a paid spokesperson for NuVasive®, Inc.