Spine

Spine pain | diagnosis, treatment

Ból kręgosłupaThe spine pain is one of the most frequent causes of disability among working population! As many as 50-80% of adults experience back pain, while 40% feel pain every year. These data look serious so it is advisable to have a closer look at the issue of spine pain.

Spine pain – causes

There are two causes of spine pain: mechanical and chemical. The mechanical-based back pain is the main cause of spinal issues. Current scientific research shows that 97-98% of spine pain results from mechanical factors.

Vast majority of these complaints (up to 90%) arise from damage to intervertebral disc. Such pain may occur when we make a sudden movement or lift a heavy item. This being the case, the patient may feel spine pain which is likely to radiate, e.g. to the limb. There is also another painful condition which results from overloading, and therefore loss of flexibility and proper mobility of spinal tissues. The cause of such pain may be previous injury, medical surgery, or damage to intervertebral disc, as well as sedentary lifestyle and monotonous posture throughout the day. The last group of back pain is a postural syndrome which applies mostly to young people; the main cause is the wrong body posture.

The chemical-based back pain entails regular symptoms. The patient has a difficulty in finding a position which lets him or her relieve while every movement intensifies the pain. Additionally, there may be the following symptoms: swelling, reddening and increased temperature of the painful spine spot.

Spine pain syndrome – division

  • If your spine starts aching suddenly or little time has passed from early symptoms to sharp pain, we deal with acute pain.
  • If the pain developed in time, early occurring occasionally, then intensified and finally is a daily problem, we deal with chronic pain.

Spine pain – lumbosacral spine

Ból kręgosłupaPain in the lower part of the spine is usually a result of mechanical factors. These include static spine overloading arising from work in unfavorable position or sudden dynamic overloads. Pain is generated by organism when a permissible range of movement is exceeded or when the load is too considerable, thus preventing its damage.

 

Lumbar herniated disc

Ból kręgosłupa

Disc hernia accounts for 60-80% of all causes of pain of the lumbar herniated disc, most frequently applies to persons aged 30-50. It is a kind of intervertebral disc hernia which entails rapture of external layer of the disc and its protrusion outside, which leads to pressure of nerves, muscles and blood vessels. A direct cause of the disc hernia may be a rapid bend or bend with additional rotation, which relocates the intervertebral disc (nucleus pulposus) to the back, thus causing rupture.

Disc hernia is most frequently a long-term process accompanied by intensive periods. The above-mentioned pressure of nerve root results in the so-called sciatic neuralgia. It is a very unpleasant acute pain which goes through a leg. The pain is so sharp that the patient has difficulties in straightening up and his or her leg goes numb.

Lumbar degenerative changes

Degenerative changes occur as we get older, the peak time is when we are 50-60 years old. They may be a result of limited physical activity and in effect weaker muscles. The consequence is overloading of spine vertebrae and tissues which are not accustomed to strenous loads (sedentary lifestyle). The pain is permanent or intermittent and intensifies when moving or when standing for a long time.

If degenerative changes are not highly intensive, it is possible to treat them in a conservative way. It is primarily based on motor rehabilitation and education related to necessary changes to everyday life. It is also possible to support the rehabilitation via therapeutic injections.

Overload syndromes

It is one of the most frequent causes of chronic spine pain. It is a combination of overloads of muscles, ligaments and intervertebral discs due to hard physical work, sport or improper positions. The pain sometimes occurs always from the spine, in remote body parts. Depending on the factors and intensity, they may be diverse. However we should always consider them as a warning and decide to visit a specialist for advice.

Pars fracture and spondylolisthesis

Pars fracture is a rupture of a vertebra. As a rule young people who do sports deal with this problem. Pain is local, usually intensified on one side. When the vertebra located above moves to the front in relation to the lower vertebra, we deal with a spondylolisthesis. It may emerge on the basis of previous pars fracture or due to considerable instability in the course of degenerative changes. Both disorders may be treated on a rehabilitation basis. In particular a pars fracture requires a quick diagnosis as the bone defect can heal spontaneously. If the conservative treatment proves to be ineffective, we may perform a surgical vertebra isthmus unification (place in which pars fracture occurs) or we stabilize the spine.

Spine pain – Cervical spine

Ból kręgosłupaCervical spine pain is the second most frequent spine pain. It is more and more common not only among persons leading a sedentary lifestyle but persons who sit at work. This disorder is often afflicted by needlewomen, laboratory employees working with microscopes, as well as computer operators. It is related to a long-lasting static position, lack of physical activity and improper position when taking everyday actions. For this reason it is highly important that we pay attention to suitable position of our head and body posture.

A long-lasting overload may lead to cervical dyscopathy, which accounts for nearly 50% of all causes of pain in this part of the spine. The cervical pain syndrome may take various forms: pain, tenderness, increased muscle tension, stiffness, and even immobility. Sometimes there are accompanying symptoms: back pain, neck pain, pain between shoulder blades, headache, jaw ache and earache, and vision impairment. The neck disorder is defined as interdisciplinary because the treatment may be performed by orthopedists, neurologists, rheumatologists and physiotherapists.

The cervical spine is prone to degenerative changes and this is because of its substantial mobility and susceptibility to overloads. The pain may be acute, related to inflammation or damage, as well as chronic, related to degenerative changes or cancer.

The cervical spine pain may also be associated with bad emotional condition. Stressful situations cause extensive tension of the neck and shoulders and in effect pain. Persons who become depressed or have mental issues may suffer from chronic and hard-to-treat complaints.

  • Cervical spondylosis
  • As tissues get older and older, a cervical spondylosis occurs, that is a series of degenerative changes to vertebrae, intervertebrae discs, joint cartilages and facet joints. It is a chronic process which lasts many years and which results from a series of all injuries and overloads.
  • Cervical radiculopathy
  • It is a pain syndrome related to pressure of nerve root. Radiculopathy causes stiffing and weakening and may result in upper limb paresis. Brachialgia is known for causing a pain which radiates from the neck to the upper limb. At the early stage the pain may intensify when sneezing or coughing but later in the process gets stronger and radiates to the shoulder. The persons can feel the pain when moving a head and the pain radiates to shoulder blade, chest and fingers.

    The most frequent cause are degenerative changes to the spine related to aging of the organism and lifestyle. Hard physical work as well as repeating the same actions in a wrong position lead to protuberances which press roots. Other examples of the cause may be micro-injuries and inflammatory conditions or tumors.

  • Upper cervical syndrome
  • It is also referred to as Barre-Lieou’s syndrome. The pain can be localized mainly in the upper part of the neck and back of the head, sometimes radiating to the temple and forehead. The main cause of the syndrome is degenerative changes to the cervical spine leading to pressure of vertebral arteries and nerve structure.
  • Neck migraine
  • Headache which comes from neck is related to dysfunction in the musculoskeletal system of the cervical spine and accounts for about 15% of all headaches. The main cause is degenerative changes which lead to irritation of the sympathetic plexus of arteries or pressure of vertebral artery. The studies show that migraine more often applies to women than men. Office workers who need to keep their heads in the same position, e.g. in front of a screen, are most prone to this condition. A long-lasting pain may also arise from wrong position during sleep.
  • Cervical spine injuries
  • The cervical spine pain often results from an injury, such as dangerous road accidents (bending and extension injury) or fall from height (compression fracture or crushing fracture). A bending mechanism of the spine injury is a result of a enormous force which causes a spine to bend forward suddenly to the extent beyond its range of mobility. As a consequence the vertebral bodies are dislocated. The extension mechanism of spine injury occurs when you are subject to forces impacting our head from the front, which leads to a sudden extension with damage to vertebrae disc and rupture of ligament.

However Whiplash-type cervical injuries are a way more dangerous. It is a typical injury in case of car accidents. As a result of the force, you bend your neck rapidly and move the head behind the shoulder. Afterwards you inertly move your head back forward. The symptoms are cervical spine pain and chest pain as well as headache lasting many months. It may be accompanied by dizziness, impaired vision and loss of balance. Sometimes mood swings, sleep disorders or faints are observed. In such cases it is necessary to immobilize the neck with the use of a cervical collar and keep it for 2-4 weeks.

Spine pain – spine damage:

  • Sudden injury – damage to tissues of the disc fibrous ring under the influence of rapid and strong injury.
  • Chronic overloads – emerging throughout years, leading to damage to vertebrae and intervertebral discs.

Spine pain – treatment

To treat the spine pain, it is necessary to eliminate the cause, rather than symptoms only. The patient who can feel pain is advised to make movements which can help them heal. Such decisions are based on results of the spine function test. According to statistics, nine out of ten patients who have experienced spine pain are likely to experience another one within a year, while for one out of three persons – symptoms will get more intensive. In view of such pessimistic data, it is important that we prevent recurrence of such pain.

The primary method of treating the patients is to educate them. The patients must learn to do everyday things in other way, e.g. sit, take shoes on, get up or lift items from the floor. Such treatment makes the patient independent as well as familiar with emergency and preventive procedures, thus helping them prevent recurrence.

In most cases the treatment is focused on rehabilitation. Each patient is assigned a specific rehabilitation plan. Its assumption is to limit pain as soon as possible so that the patient can take everyday activities. At next stage we concentrate on reinforcing effects and preventing recurrence. In special cases, when doctors find the progress unsatisfying, it is possible to resort to injection-based surgery. After the surgery, the patient should return to rehabilitation program.

With regard to serious neurological symptoms (acute pain in the limb, sensation disorders and impaired muscle strength in the limb) which do not sustain but, quite the opposite, intensify, we suggest that the patient should decompress nerve structure urgently. It is possible thanks to discectomy. After the surgery, rehabilitation is the priority. Its task is to prevent recurrence of the above in the future.

In special cases, especially speaking of older people who sustain minor injuries or sudden overloads, there may be a compression fracture in the vertebra. The patient complains about acute pain which intensifies when moving or changing positions. The very fracture resembles crushing the box. It is necessary to do imaging examinations which can help us establish which vertebra was fractured and how large the deformation is. In the process of treating this kind of fractures, we adopt the vertebroplasty.

If the changes are highly advanced, when spine degeneration is considerable or intensity of neurological symptoms is high, a surgery may turn out to be a must. Its range and precise technique is established on a case-by-case basis. All surgeries are concerned with stabilizing the spine with various kind of compression of nerve structures. In the aftermath of the surgical treatment, it is necessary to initiate rehabilitation which can help the patient return to normal life and learn suitable habits.

Spine pain – most important – primary prevention!

You have to get into the habit of protecting a spine to make sure everyday activities you take automatically and often improperly do not cause spine micro-injuries and overloads to overlap.

References:

Piotr Józefowski, Anna Kołcz-Trzęsicka, Anna Żurowska, “Zdrowy kręgosłup” [Healthy spine], Warsaw, Publishing house SBM Sp. z o.o., 2015, ISBN 978-83-7845-875-3