There are many different causes of back pain. Some of the most common are: arthritis of the spine, scoliosis, muscle spasms, strain or sprain, annular tears, bulging discs, herniated discs, pinched nerves, extruded discs, stenosis, infection, tumor and fractured (broken) bones. This is a not a complete list, but these are the most common causes of neck or back pain.
There are many different causes of neck pain. Some of the most common are: arthritis of the spine, scoliosis, muscle spasms, strain or sprain, annular tears, bulging discs, herniated discs, pinched nerves, extruded discs, stenosis, infection, tumor and fractured (broken) bones. This is a not a complete list, but these are the most common causes of neck or back pain.
A bulging disc is generally a bulge of the outer covering of the disc (the annulus fibrosis) by the inner material of the disc that results in pressure of a nerve. The difference between a bulging disc and a herniated disc is a bulging disc is contained by the outer covering. Think of a bubble in a tire. The outer covering of the tire does not rupture, but there is an obvious bulge. This may cause sciatica.
A herniated disc occurs when the gel-like inner portion of the disc ruptures or breaks through the outer covering of the disc and presses on a nerve. This may cause sciatica.
An extruded disc occurs when the entire inner portion of the disc completely ruptures through the outer covering of the disc and moves freely within the spinal canal. This may cause sciatica.
A “pinched nerve” or pressure on a nerve can be caused by a number of conditions. The most common are disc bulge, disc herniation, arthritis of the spine, or spinal stenosis. Pinched nerves can occur in the cervical (neck), thoracic (mid back), or lumbar (low back) regions.
Arthritis of the Spine
Arthritis of the spine can occur in the cervical (neck), thoracic (mid-back) or lumbar (low back). It occurs in the small joints of the vertebrae called facet joints. As we age, these joints can enlarge and lose their protective cartilage. This causes pain. Arthritis of the spine has also been called, incorrectly, degenerative disc disease. Degenerative disc disease is a breakdown of the discs between the vertebrae and is technically not true arthritis. Regardless, both of these condition cause pain and can be treated effectively with physical therapy, injections or surgery.
A herniated disc should be evaluated by a spine specialist who will perform a thorough clinical evaluation, which will include a history and physical examination. Careful assessment for any weakness, loss of sensation, or abnormal reflexes will be done at the time of your exam. Furthermore, if there are any problems with bowel or bladder function, this is considered a surgical emergency.
An MRI confirms a diagnosis of a herniated disc. An MRI is not indicated for approximately six weeks after the onset of symptoms, unless there are other warning signs that are evident at the time of the history and physical examination. An MRI is the preferred diagnostic study when evaluating for a herniated disc. However, some patients are not able to undergo an MRI, such as those patients with a pacemaker, and a CT scan can be used.
Spinal stenosis is a narrowing of the spinal canal. The bones of your spine (vertebrae) form a column or canal that protects your spinal cord. Your spinal cord runs through this canal. Over time, spinal stenosis may develop which compresses the spinal cord. Spinal stenosis occurs anywhere throughout the spine, but it is most common in the lumbar (low back) and cervical (neck) regions of the spine. Spinal stenosis occurs when the discs lose water content and become less “spongy” as we age. This results in a loss of the disc height and a bulging or hardening of the discs causing narrowing of the spinal canal. Arthritis can cause bones and ligaments of the spine to thicken and enlarge. This may also cause pressure on the spinal canal or nerves.
Spinal stenosis does not always cause symptoms; however, many patients with lumbar (low back) spinal stenosis have difficulty walking more than two or three blocks or standing up straight for an extended period of time. Many patients with spinal stenosis can walk longer distances if they lean forward, such as when holding onto a shopping cart. This is known as a “shopping cart sign.” Sitting tends to relieve the symptoms of spinal stenosis because leaning forward or sitting relieves the pressure on the nerves. Spinal stenosis symptoms are made worse by leaning backward. Very rarely, spinal stenosis can cause bowel or bladder symptoms.
Cervical stenosis occurs in the neck region. This is a more serious condition and generally requires surgery. Cervical stenosis can cause changes within the substance of the spinal cord resulting in difficulty with balance and walking. Cervical stenosis may cause incoordination of your hands and feet. Patients typically drop objects frequently and having difficulty manipulating small objects.
You should have a complete evaluation by a spinal specialist if you develop any symptoms of spinal stenosis.
A bone spur is an outgrowth of the facet joint. Facet joints are small joints within the spinal column. These joints become arthritic and bone spurs grow in response to the arthritis in the joints. When bone spurs grow in the back or neck, a pinched nerve or spinal stenosis may result. Bone spurs can only be removed surgically.
Degenerative Disc Disease
Degenerative disc disease (DDD) is a breakdown of the intervertebral disc. This disc acts as a cushion between the bones of the spine. As we age our discs lose their water content and they degenerate. A degenerated disc cannot provide adequate cushioning between the bones of the spine. The bones begin to rub together and this causes pain. The mainstay of treatment for degenerative disc disease is physical therapy and injections. Sometimes surgery may be required.
Spondylolisthesis is a slippage of one spinal bone on another. This most commonly occurs in the lumbar (low back) spine but can occur in others areas. Spondylolisthesis causes spinal stenosis and sciatica. Patients with spondylolisthesis complain of leg pain, back pain and difficulty walking long distances. It is treated with physical therapy, injections and surgery. Surgery has proven to be the most effective treatment for this disease.
Scoliosis or spinal deformity is a curvature of the spine that can occur in the cervical (neck), thoracic (mid back) or lumbar (low back) region. It can occur during childhood, known asidiopathic scoliosis, or during adulthood, known as degenerative scoliosis. Childhood scoliosis is generally treated with a brace; however, bracing is not effective for the treatment of scoliosis in adults. Patients with a diagnosis of scoliosis require an evaluation by a spine specialist. Genetic testing is available to predict the progression of childhood scoliosis in some children.