Defects and Diseases of the Spine - Back pain and its causes



Most adults have experienced some form of back pain. Back pain is a serious physical impairment in persons of all ages, but it occurs more frequently in older persons.

Lumbago and Sciatica

Lumbago refers to general pain in the lower back. Technically, it is not a disease but a symptom that is accentuated by bending, lifting, turning, coughing, or stooping. Pain from neuritis of the sciatic nerve adds to one's misery, with pain shooting down the legs. This form of back pain is commonly known as sciatica , and, like lumbago, can be considered a symptom of some other condition. Treatment depends on the underlying cause of both.

Sciatica

Slipped and Herniating Disks

Between each two vertebrae is a fibro-cartilaginous disk that acts as a cushion. These disks are subjected to strain with every movement of the body, especially in the erect position. Increased pressure may cause a disk to protrude or herniate into the vertebral canal, causing what is referred to as a slipped disk . This condition can also be brought on by injury, degeneration caused by aging, unaccustomed physical activity, or heavy lifting.

Herniated Disk

The herniating disk presses against nerves in the area, resulting in low back pain, sciatica, and in some instances, disabling muscle spasm. Back rest and a surgical corset may help milder forms of slipped disk by allowing natural healing to take place. Treatment may also include bed rest with intermittent traction to the legs for several weeks. Spinal fusion may be required in severe cases.

A severely herniated disk can be surgically removed to relieve pain and other symptoms. Disk removal is followed by fusion of the vertebral bodies on both sides of the removed disk. Fusion is accomplished by bridging the vertebral space with a bone graft. For a fuller description of surgical repair of a slipped disk, see under “Orthopedic Surgery” in Ch. 20, Surgery .

Spondylolisthesis

A forward displacement of one vertebral body over another results in a painful condition known as spondylolisthesis . In mild cases there may be no symptoms at all. But in more advanced forms, there is severe low back pain when in the erect position and on bending, with the pain radiating to the legs. The displaced vertebra interferes with nerve roots in that area.

Mild cases require no treatment. Severe cases may require fusion of the vertebral segments with bone grafting; less severe symptoms can be relieved by a specially fitted corset.

Muscle Spasms arid Strained Ligaments

Lack of physical exercise and unaccustomed bending can cause acute backache from undue muscle strain. Backache from strain on the ligaments is not uncommon in women following childbirth. The symptoms are similar to general low back pain. Physiotherapy with moist heat and massage helps restore muscular tone and relieve the pain. Muscle-relaxing drugs are sometimes prescribed.

Sacroiliac Pain

The sacroiliac joints in the lower back, where the iliac (hipbone) joins the sacrum, are a common location for osteoarthritic changes, rheumatoid arthritis, tuberculosis, and ankylosing spondylitis. The most common site of pain is in the lower lumbar region, radiating to the thighs and legs. X-ray diagnosis helps to pinpoint the cause of this particular form of back pain.



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