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Back Pain
 Your spine and back are some
of the most vital parts of your anatomy - providing
structural support, movement and protection of
certain tissues and organs. Unfortunately
because of this daily grind, it’s been said that one out
of four people will experience back pain at some
point during his/her life. Back pain typically
refers to problems in: the vertebrae bones, intervertebral
discs, the spinal cord and nerves and/or the ligaments
and muscles around the spine.
With that being said, there are numerous causes
- ranging from muscle strain to trauma, arthritis,
disc damage, fractures, muscle spasms, facet joint
pain, spinal instability, and/or the cumulative
effect of poor body mechanics.
Symptoms
Symptoms vary from minor discomfort to soreness,
numbness, tingles, throbbing, mild paralysis, and
depending on the source of the pain, can extend
into the arms and legs.
Treatment
Unfortunately
there is no “magic pill” for curing
back pain, as there is no single treatment
that works for all patients. Conservative
treatment methods include: anti-inflammatory
medications, muscle relaxants (cortisone
or epidural injections), physical therapy
(heat, massage, ultrasound, electrical stimulation,
acupuncture), regimented exercise (stretching,
pilates, chiropractic care), or quite simply,
prolonged rest. However, with unrelenting
chronic pain or severe impairment of function,
surgery may be necessary. The operation performed
depends on the diagnosis or suspected cause,
the overall status of the spine, and the
age and health of the patient.
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Sciatica
The sciatic nerve is the largest peripheral nerve in the body that starts in the lumbar and sacral nerve roots in the spine, and extends through the back of the leg. Among other things, the sciatic nerve supplies sensory information about movement in the leg.
Symptoms
There’s
a big difference between normal leg cramps and
the kind of chronic, debilitating pain that makes
it difficult to walk, let alone stand. The latter
is usually characteristic of sciatica, a diagnosis
indicating inflammation of the sciatic nerve. When
the nerve is affected by direct pressure (for instance:
from a disc, adjacent bone, tumor or internal bleeding),
it can alter normal functions and cause persistent
weakness or numbness, a tingling lower back, and
intense shooting pains from the thigh down to the
knee.
Treatment
Anti-inflammatory
medications can be given to reduce the swelling
of tissues that are pressing against the nerves,
and most patients will feel better in less
than three months. The good news though, is
that since the nerve is rarely permanently
damaged, most patients will fully recover from
sciatica and most likely without surgery. In
the case that surgery is required, the typical
procedure involves opening up the area in which
the nerve is being compressed, for instance,
removing a disc or retracting tissues.
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Spinal Stenosis
Stenosis is an abnormal narrowing
of the central spinal canal, which holds the spinal
cord. The narrowing, most often found in the lumbar
or cervical regions, may be caused by age-related
changes of the spine, such as degenerative disc
disease, or osteoarthritis, which causes a bone
buildup in and around the canal.
Symptoms
The
result is an increased compression of the nerve
roots branching out from the area, which may
give rise to pain or numbness in the legs, arms
or shoulder.
Treatment
While
anti-inflammatory medications are often first
used to minimize swelling, the most common treatment
is eventually a spinal decompression in which
the narrowing around the nerves is removed. This
can be accomplished through a laminectomy (removal
of the entire lamina or bony wall of the spinal
canal) or laminotomy (a newer version of the
laminectomy in which only a small part of the
lamina is removed through a small hole).
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Disc Herniation
The intervertebral disc (or disc for short) is a cushion or circular-shaped piece of tissue that separates the bones of your spinal column. The center of the disc, called the nucleus pulposus, is soft, springy and acts as a shock absorber for daily activities like sitting and standing. The annulus or outer ring of the disc consists of a series of interwoven layers of fibrous tissue, to provide structure and strength. You can imagine the disc, quite simply, like a jelly doughnut.
When the filling oozes out (the nucleus pushes outside of its normal position), the result is a disc herniation. The term herniated disc is often used along with ruptured disc, slipped disc, bulging disc and/or pinched nerve, though there are subtle differences. For instance, with a bulging disc, there is only a slight protrusion of the nucleus, and the annulus fibrosus has not been fully ruptured.
A herniated disc is problematic because there is normally little space around the spinal cord and spinal nerves already, so if enough of the disc is pushed out of place, then these structures may be compressed. Herniated discs typically result from normal aging, as a disc loses hydration over time and develops small tears, or from an injury, like a fall.
Symptoms
The
direct pressure results in varying degrees of
pain in the back, leg and lower extremities,
including any combination of burning, numbness,
tingling or pins and needles. Interestingly,
the severity of pain from a herniated disc does
not always correlate to the amount of physical
damage of the disc. Sometimes a large herniated
disc may be completely painless, while a muscle
spasm from a simple back strain may cause excruciating
pain. The key factor is to determine whether
the patient has a pinched nerve (radicular) or
if the pain is in the disc space itself (axial).
Treatment
If
conservative measures do not relieve symptoms,
surgical treatment may be recommended. Contingent
on the size and location of the herniated disc,
common procedures are a: discectomy (partial
or entire removal of the damaged disc or nucleus
to free up space around the compressed nerve),
percutaneous discectomy (removal of the disc
by needle technique) or chemonucleolysis (dissolving
the disc). Recovery varies depending on the surgery,
but most patients are active after six to eight
weeks, and can fully resume their normal lifestyles
in one year.
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Degenerative Disc Disease
Degenerative
disc disease is a natural wear-and-tear process
that weakens the cartilage-like-discs between vertebrae
bones and causes them to dry out and crack. In
our youth, discs are soft and elastic, but as we
age, the water and protein content changes (similar
to tendons and ligaments) and the discs become
more rigid and vulnerable. When this happens, the
disc loses its abilities for shock absorption and
places extra pressure on the surrounding nerve
roots – thereby predisposing the back to significant problems in the future. According to the North American Spine Society, even in individuals as young as 30, MRI’s
show evidence of disc deterioration in about 30
percent of people.
Symptoms
It’s
important to mention that over time, everyone actually
exhibits changes in their disc consistent with
degeneration, however, not all people will develop
symptoms. The disorder is progressive with problems
such as limited flexibility and incapacitating
pain.
Treatment
The
most effective remedy is usually surgery -
either fusion or the newer artificial disc
replacement.
Fusion
is a surgical procedure following a discectomy
(partial or entire removal of the damaged disc
or nucleus to free up space around the compressed
nerve). The goal is to remove the damaged disc,
replace it with a graft, and also stimulate
bone growth in the same area.
While
this procedure is the most common and provides
effective, immediate pain relief, there can
be disadvantages. Namely because the space
once occupied by a flexible disc is now occupied
by a bone, natural movement is disallowed at
the damaged level, which can lead to stiffness,
and stresses are often transferred to discs
below and above, which can lead to potential
future problems.
In
October 2004, the FDA approved another approach
that achieves the same pain reduction as fusion
but without some of the complications. With
artificial disc replacement, a prosthetic implant
is substituted for the damaged disc. The disc
is designed to retain the natural movement
of the spine by duplicating the shock-absorbing
and rotational function of the original disc.
With this type of surgery, the biggest advantage
is that the disc allows motion at the damaged
level so patients can more or less return to
their normal, active lifestyles. Also since
there is no time spent waiting for the bone
to heal and fuse, the recovery is much shorter
and patients can usually return to work in
six to eight weeks instead of the three to
six months typical with fusion.
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Neck pain
Cervical pain refers to pains in the neck. Two serious treatable conditions are disc herniations and stenosis. With both, the spinal cord or nerve roots in the neck are compressed significantly.
Symptoms
The compression can lead to problems with: arm
or leg strength, balance control, sensory symptoms,
bowel or bladder dysfunction and/or cause pain.
Treatment
It often consists of removing the offending disc
(discectomy) or removing the ligaments or bony
structures that impinge upon the spinal canal (laminectomy).
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