Back Pain Causes and Treatments
Why do I have back pain?
Back pain is a common source of suffering, depression, disability, economic loss and narcotic addition in America today. Back pain is so common that 90% people will have it during their lifetime and 50% of workers are troubled by back pain each year. These results in one out of six doctor visits are for new back pain.
Back pain may arise from the spine (bony vertebrae, disks, facet joints, muscles or ligaments) or outside of the spine (lungs, heart, abdominal organs, etc). Often the exact cause of the pain is difficult to determine without extensive tests. This has led physicians to classify back pain as primary (non-specific or mechanical) or secondary. Non-specific back pain makes up 98% of back pain and is not life threatening. Secondary back pain may be caused by cancer (primary or metastatic) or infection (vertebral osteomyelitis or spinal epidural abscess).
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.
What are the common causes of Back Pain?
Common causes of back pain are degenerated disk disease, disk herniation, spinal stenosis, vertebral compression fractures and spinal instability and spondylolithesis.
Degenerative Disk Disease
As people age their disks wear out, collapse and tear resulting in a degenerated disk with annular tear. Blood vessels and nerves grow into the tear causing back pain. Patients may benefit from removal of the disk and burning of the annulus (endoscopic discectomy and annuloplasty) or endoscopic fusion (endoscopic lumbar interbody fusion).
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 sciatic nerve causing sciatica leg pain. The disk can be removed through a small same day procedure with a spinal endoscope called endoscopic discectomy.
Thicken ligaments and bone spurs narrow the spinal canal producing spinal stenosis. The leg nerves are pinched causing leg pain when walking called neurogenic claudication. Spinal stenosis can be removed with surgery.
Vertebral Compression Fracture
Spinal vertebrae weakened by osteoporosis may break with minimal trauma causing severe back pain. Pain results from micro-motion in the fracture worse when standing or walking. The back pain can be injection of bone cement into the fracture during vertebroplasty or kyphoplasty.
Wearing out or injury to the back may weaken the back joints and ligaments producing painful motion and misalignment of the spine called instability and spondylolithesis. The spine can be realigned and strengthen through spinal fusion surgery such as endoscopic fusion.