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Sunday, April 20, 2014
The lumbar region of the back, where most back pain is felt, supports the weight of the upper body. Conditions that may cause low back pain and require treatment by a physician or other health specialist include:
The intervertebral discs are under constant pressure. As discs degenerate and weaken they dry out (dehydrate), causing them to lose height, and sometimes leading to small cracks or tears in the surface of the disc. This can cause lower back pain. Less commonly, cartilage can bulge or protrude into the space containing the spinal cord or a nerve root, causing pain. Studies have shown that most bulging discs occur in the lower, lumbar portion of the spinal column. It is important to realize that bulging discs are not always painful; studies have found that many people with no back pain have bulging spinal discs. It requires expertise from a health care provider to determine whether your bulging disc(s) is (are) the cause of your back pain, or is (are) unrelated.
Also called "slipped disc" or "ruptured disc". This occurs when a piece of cartilage from the center of an already weakened disc, with a crack or fissure through the surface, suddenly "squirts out" into the spinal canal, often causing pressure on a nerve root, or even the spinal cord (in the cervical or thoracic region). This often causes back (or neck) pain, but also causes severe pain in the arm or leg. Depending on how badly the nerve is compressed, numbness, tingling, or even weakness can result as well. A much more serious complication of a ruptured disc is "cauda equina syndrome", which occurs when disc material is pushed into the spinal canal and compresses the entire bundle of lumbar and sacral nerve roots. This causes not only severe leg pain and weakness, but also loss of control over bowel and bladder function. Because permanent neurological damage may result if this syndrome is left untreated, this condition is an emergency.
Sciatica refers to any irritation or inflammation of the sciatic nerve, the largest nerve in the body. The sciatic nerve forms when several lumbar nerve roots join together in the pelvis. From there, it exits the pelvis under the buttock muscle, and runs down the back of the leg to the foot and toes. The most common cause of sciatica is actually not from pressure on the sciatic nerve, but from pressure on one of the lumbar nerve roots that form the sciatic nerve. This is usually caused by a herniated disc or other spinal problems pushing on the nerve root. This compression causes shock-like or burning low back pain combined with pain through the buttock and down one leg to below the knee, occasionally reaching the foot. In the most extreme cases, when the nerve is pinched between the disc and an adjacent bone, the symptoms involve not pain but numbness and some loss of motor control over the leg due to interruption of nerve signaling. The condition may also be caused by a tumor, cyst, metastatic disease, direct trauma to the nerve, or degeneration of the sciatic nerve itself. There is also a syndrome called "pyriformis syndrome" in which an abnormally tight muscle under the buttock pinches the sciatic nerve where it exits the pelvis.
Spinal Stenosis is one of the most common problems affecting the spine, especially in older people. It is a gradual degenerative process, in which bulging discs and arthritis in the spinal joints ("facets" or "facet joints") combine with abnormal thickening of the spinal ligaments to cause progressive narrowing of the spinal canal. When this narrowing gets bad enough, it causes severe pressure on the spinal nerves and/or spinal cord. Lumbar stenosis is the most common type of stenosis, and while it can cause back pain, the hallmark symptom is called "neurogenic claudication". People with this symptom have no pain when they are sitting or lying down, but after a few minutes of standing or walking they get terrible pain, numbness, tingling and/or weakness in their legs. If they sit down and rest, the symptoms usually rapidly go away. Your health care provider has to distinguish this problem from "vascular claudication", in which poor blood circulation causes the same symptoms. Most spinal stenosis is "degenerative", as described above; spinal stenosis can also be congenital, meaning the person was just born with an unusually narrow spinal canal, putting them at higher risk for nerve compression problems later in life.
Osteoporosis is a metabolic bone disease marked by progressive decrease in bone density and strength. Fractures of brittle, porous bones in the spine and hips result when the body fails to produce new bone and/or absorbs too much existing bone. Women are four times more likely than men to develop osteoporosis. Caucasian women of northern European heritage are at the highest risk of developing the condition. Over 700,000 spinal fractures per year are caused by osteoporosis in the United States alone, often with little or no trauma, such as picking up a bag of groceries, stumbling down one or two steps, etc.
Skeletal irregularities (also referred to as "deformities") produce strain on the vertebrae and supporting muscles, tendons, ligaments, and tissues supported by spinal column. These irregularities include:
Fibromyalgia: Fibromyalgia is a chronic disorder characterized by widespread musculoskeletal pain, fatigue, and multiple tender points, particularly in the neck, spine, shoulders, and hips. Additional symptoms may include sleep disturbances, morning stiffness, and anxiety.
Spondylitis refers to chronic back pain and stiffness caused by a severe infection to or inflammation of the spinal joints. Other painful inflammations in the lower back include osteomyelitis (infection in the bones of the spine) and sacroiliitis (inflammation in the sacroiliac joints). Osteomyelitis and discitis (infection of the intervertebral disc) are potentially life-threatening infections that, if not treated, can cause sepsis ("blood poisoning" or spread of bacteria into the blood stream), or even an "epidural abscess", which is a walled-off pocket of pus in the spinal canal. Epidural abscess is an emergency requiring immediate surgery. Without immediate treatment, epidural abscess can lead to permanent paralysis or even death.
Tumors can arise anywhere in the spine. The most common type of spinal tumor is a cancer that has spread to the spine from somewhere else in the body ("metastasis"), especially lung cancer, breast cancer, and prostate cancer. There are also more rare tumors that originate in the vertebrae or even in the spinal cord or nerve roots themselves. Symptoms vary widely depending on the location, size, and site of origin of the tumor, but can include spinal pain, numbness, weakness, tingling, inability to walk, etc. Careful evaluation by a spine specialist is required to diagnose a tumor of the spine. Treatment can include observation (for very benign, slow-growing tumors), biopsy, radiation, chemotherapy, surgery, or a combination of these treatments.
Source: National Institute of Neurological Disorders and Stroke - Low Back Pain Fact Sheet
Many research studies are underway to help us learn about spine and back conditions. Would you like to find out more about being part of this exciting research? Please visit the following links:
Last Reviewed: Oct 12, 2011
David J Hart, MD
Associate Professor of Neurosurgery
School of Medicine
Case Western Reserve University