Spine

LOW BACK PAIN OVERVIEW

Low back pain is one of the most common disorders in the United States. About 80 percent of people have at least one episode of low back pain during their lifetime.

Factors that increase the risk of developing low back pain include smoking, obesity, older age, female gender, physically strenuous work, sedentary work, a stressful job, job dissatisfaction and psychological factors such as anxiety or depression.

 

 

 

 

back pain

 

STRUCTURE OF THE BACK

The back is formed by bones, muscles, nerves, and other tissues that work together to help us stand and bend. The bones of the back are called vertebrae, which together form the spinal column. The spinal column protects the spinal cord, part of the central nervous system that controls our ability to feel and move.

The spinal cord passes through an opening on the back of the vertebrae. The vertebrae are stacked one on top of another. Small nerves (called nerve roots) exit from the spinal cord and pass through spaces on the sides of the vertebrae. The spinal column extends below the base of the spinal cord. The nerve roots to the lower back and legs are together called the cauda equina, or horse's tail.

Between each pair of vertebrae in the spinal column is a disc composed of a tough outer tissue and a gel-like inner pulp. These discs protect the bones, acting like cushions or shock absorbers. The vertebrae are held together by ligaments and tendons, allowing the vertebrae to move together as the spinal column bends forwards, backwards, and side to side.

There are four main regions of the back; the cervical (C), thoracic (T), lumbar (L), and sacral (S) regions.

 

 

  • The 7 cervical vertebrae are located in the neck
  • The 12 thoracic vertebrae are located in the upper back
  • The 5 lumbar vertebrae are located in the lower back
  • The sacrum and coccyx are fused bones, found at the base of the spinal column

 spinal column

The vertebrae are numbered from top to bottom. As an example, the top lumbar vertebra is called the L1 vertebra. Low back pain occurs in the area of the lumbar and sacral vertebrae, most commonly at L4, L5, and S1.

 

LOW BACK PAIN CAUSES

Low back pain can have many causes. However, most people (>85 percent) have "nonspecific low back pain", which is not caused by a specific disease or abnormality in the spine. Many people attribute their back pain to a degenerating disc or arthritis, although problems in muscles or ligaments or other causes may be equally responsible.

Rarely, back pain is caused by a potentially serious spinal condition, such as infection, fracture, or tumor, or a disorder called cauda equina syndrome, which causes weakness and bowel or bladder dysfunction as well as back pain. Back pain that is associated with leg pain can be due to a herniated disc or spinal stenosis.

Degenerative disc disease:  Wear and tear can lead to degenerative disc disease, or the breakdown of the spinal discs, with small cracks and tears and/or loss of fluid in the discs.  This can lead to other changes including the formation of bone spurs. Calling this condition a "disease" is somewhat misleading because these changes occur with normal aging and frequently cause no symptoms. In fact, many people have degenerative disc disease seen on x-rays or other imaging studies but have no pain or other symptoms.

Facet joint arthropathy:  Facet joint arthropathy refers to arthritis in the joints connecting the vertebrae to one another (facet joints). This can lead to bone spurs around the joint and may cause low back pain. However, like degenerative disc disease, facet joint arthropathy is very common with aging and many people have no symptoms.

Spondylolisthesis:  Spondylolisthesis is a condition in which one of the vertebrae of the lower spine slips forward in relation to another. Spondylolisthesis is usually caused by stress on the joints of the lower back and may be associated with facet joint arthropathy. Although this condition can cause low back pain and sciatica, sometimes it causes no symptoms at all and is diagnosed with an x-ray done for another reason.

 

spondilolisthesis

Herniated disc:   Too much wear and tear on spinal discs can lead to herniation of a disc, in which the outer covering is weakened or torn, and the soft inner tissue extrudes (a "slipped disc"). Herniated discs can cause leg pain or weakness if the disc pinches a nerve root. However, herniated discs are frequently seen on x-rays, even in people with no low back pain. Herniated discs usually heal over time because the body breaks down the excess disc material and water within the disc is absorbed, relieving pressure or irritation on the nerve.

 

disk

A bulging disc protrudes less than a herniated disc. It is more common than a herniated disc and is seen in half of people who have no back pain. A bulging disc usually causes no symptoms, although occasionally it can cause sciatica. (See 'Sciatica' below.)

Lumbar spinal stenosis 

 Spinal stenosis is a condition in which the vertebral canal (the open space inside the vertebrae) is narrowed. This is often caused by inflammation due to one or more damaged discs, and is particularly common in older patients. Spinal stenosis can cause neurogenic claudication.  However, like herniated discs, spinal stenosis can be seen in people with no symptoms.

Less common causes of low back pain  

Rarely, low back pain is caused by a serious spinal condition, such as an infection, tumor, or a disorder called cauda equina syndrome, which causes weakness and bowel or bladder dysfunction as well as low back pain. Other potential causes include spinal compression fractures, in which one or more vertebrae become fractured as a result of weakening and thinning of the vertebrae due to osteoporosis.

In younger people, low back pain with morning stiffness can be associated with an inflammatory condition called ankylosing spondylitis 

 

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