Why do I have back pain?
It is estimated that 60-80% of the adult population will develop back pain at some point in their lives. Back pain is therefore a common source of suffering, depression, disability, economic loss and narcotic addition in America today. This results in one out of six doctor visits for new back pain. Fortunately acute back pain usually resolves without treatment within 4 weeks. Back pain has been classified as primary or secondary.
The common primary causes are due to back muscle weakness, the facet joints, degenerative disk disease, disk herniation, spinal stenosis, spinal instability, spondylolisthesis, and vertebral body compression fractures. The secondary causes are outside the spine and include abdominal organs, aorta, heart, and lungs. Secondary back pain may also be caused by cancer (primary or metastatic) or infection (vertebral osteomyelitis or spinal epidural abscess).
Non-specific back pain makes up the majority of back pain and is not life threatening.
Most back pain is self-limiting and resolves over weeks to months, but doctors become concerned if the back pain occurs in the setting of cancer, unexplained weight loss, fever, immunosuppression (decreased immune system function such as HIV or AIDS), prolonged use of steroid medications, IV drug use, pain that is unrelieved with rest, significant body injury (fall or motor vehicle accident), weakness, or bowel and bladder incontinence or retention.
Degenerative Disk Disease
As we age our disks become dehydrated, the disk collapses in height, and often develop annular tears through the region of the disk called the annulus that has nerve endings. Patients often benefit from core strengthening. When this fails patients may benefit from burning of the annulus (endoscopic discectomy and annuloplasty) or removal of the disk and fusion or disk replacement.
The disk is composed of outer annulus and inner nucleus. Disk herniation is when the outer layer of the disk weakens and the nucleus squeezes out of the disk and pinches the nerve causing sciatica leg pain. The disk can be removed through a small same day procedure with a spinal endoscope called endoscopic discectomy.
Narrowing of the spinal canal due to thickened ligaments and bone spurs cause spinal stenosis. The lumbar nerves are pinched causing leg pain when walking called neurogenic claudication. Nerves in the neck can cause pain to radiate into the scapular area or into the arm. Spinal stenosis is very common and when conservative measures fail it is easily treated surgically.
Vertebral Compression Fracture
Minimal trauma to spinal vertebrae weakened by osteoporosis can cause vertebral body compression fractures. Pain results from compression of the fracture which is often worse when upright sitting, standing, or walking. Often the fracture can be supported with a brace. If this fails then consideration for the injection of bone cement into the fracture called vertebroplasty or kyphoplasty.
Normal age related changes can cause degenerative spondylolisthesis, injury as a child often causes lytic spondylolisthesis, and trama can contribute to spinal instability. Spondylolisthesis refers to a misalignment of the spine. Core strengthening is usually the first step in treating back pain unless trauma is involved or severe neurologic problems are present such as a progressive neurologic deficit, weakness, or urinary and/or bowel incontinence.