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Back and Neck Pain

Low back pain can often be attributed to complex origins and symptoms, and it does not discriminate. It can originate from identified muscle trauma, or an unknown non-traumatic event. Low back pain can also begin in other regions of the body and eventually attack the muscles or other structures in the lower back. Sometimes low back pain can even begin in the nerves or nervous system. Other origins for low back pain are postneural difficulties, congenital disorders, trauma, infections, degenerative disorders, inflammatory diseases, circulatory disorders or any of other 30 additional causes.

 

Where Back Pain Starts

It is often difficult for physicians to pinpoint the exact cause of a patient's low back pain, because of the complex composition of the human spine. Bone, discs, muscles, ligaments, tendons and various other tissues are arranged like a three-dimensional puzzle to make up the spine. The complex make up can easily mask the exact cause of low back pain.

In addition, depression, anxiety, frustration, reinforcement, stress, anger, fear and many other psychological states can help to cause the onset of back pain, can be a reaction to prolonged pain, or exist concurrently with pain.

The emotional component can complicate the back pain diagnosis, sometimes resulting in needless surgery and disability and can sometimes mask the underlying physical causes of pain.

 

 


Mechanical Disorders

Lumbar Disc Herniation

A herniated disc is a common injury that can affect any part of the spine. A herniated disc can cause severe pain and other problems in the arms or legs.

 

 

Spondylolisthesis

Spondylolysis is a defect in the lamina of the vertebrae in the pars interarticularis, usually the fourth or the fifth lumbar vertebrae in the lower (lumbar) spine. Spondylolysis may occur as a congenital defect or be the result of repetitive trauma. Some physicians believe spondylolysis may be caused by genetics, and that someone could be born with thin vertebral bones causing them to be vulnerable to the condition. Spondylolysis is common in teenage gymnasts and football players, and presents with lower back pain that is worse with strenuous exercise or activity. Radiographic findings are subtle, but bone scans or CT scans will usually detect the lesion. Activity modification, bracing, or surgical treatment may be indicated for persistent symptoms.

Spondylolysis is a prerequisite for spondylolisthesis. Spondylolisthesis occurs when spondylolysis weakens one of the vertebrae so much that the bone slips out of place.

The condition can also be caused by degenerative disc disease. If the vertebrae slip too much and begin to press on nerves, surgery may become necessary. Spondylolisthesis may also be caused by degenerative conditions that affect the vertebral joints, such as cerebral palsy.

Early treatment usually involves rest and medication. Progressive spondylolisthesis usually requires surgical treatment.

 

 

Sprains and Strains
Most acute pain in the back results from sustaining a mild strain in the back or back musculature. Sprains and strains in your lower back usually happen during a sudden and stressful injury, causing stretching or tearing of the muscles, tendons, or ligaments in your lower back. When you strain or sprain your lower back it causes a lot of stress on your spine, irritating it. If you have this condition you may also suffer from painful muscle spasms which can occur during your daily activities or at night while you're sleeping. The pain is usually limited to five or ten days.

 

Sciatica

Sciatica is the descriptive term for when pain runs from your back or buttocks down your leg and into your foot. It is a condition caused by either compression or trauma of the sciatic nerve. Sciatica is made worse when you cough or if someone lifts your leg up while you are laying down. Symptoms may begin abruptly or gradually, are usually irritated by movement, and often grow worse at night. Sciatica implies that there is an irritation of your nerve root in the lower part of your spine. In some instances, this could be due to a ruptured or herniated disc in your lower back.

Herniated / Ruptured Discs
A herniated ("slipped") or ruptured disc in your back can cause each of these pain patterns. The ways in which a slipped disc causes different pain patterns and problems with your back is related to the location of the slipped disc along your spine, and also to the anatomy of your spinal column.
The spinal column, or backbone, consists of 33 bones (vertebrae) and can be divided into five segments, called the cervical, thoracic, lumbar, sacral, and coccygeal sections of the spine. Each of these sections corresponds to a particular part of your body. The cervical spine is that part of the spine in your neck, the thoracic spine supports your trunk, the lumbar spine supports your lower back and abdomen, the sacrum supports your pelvis, and the coccyx is your tailbone.

 

 

 

 

 

Spinal Stenosis
Stenosis produces a dull, aching pain in the lower back when standing or walking. The pain usually radiates down into the buttocks and thighs, and can be relieved by stopping to rest, or by using a walker or a shopping cart in the grocery store. These symptoms usually slowly get worse over time, and people who suffer from spinal stenosis will notice a slow decrease in their ability to walk shorter and shorter distances.

 

 

 

Lumbar stenosis is a natural product of aging, and the wear and tear on the spine throughout our lives. As our bodies grow older, the ligaments and bones that make up the spine grow thicker and become stiffer. The spinal canal gradually narrows, and the spinal cord is slowly compressed. The lack of space interferes with the normal function of the spinal cord and the body becomes less able to function normally.

 


Inflammatory and Infectious Disorders

Though infections and inflammation of the spine are rare, if they are neglected for a period of time, or if there is a delay in diagnosis, they can become a significant source of pain and disability. Bone and joint infections anywhere in the body can be crippling and life threatening.

 

Discitis
Discitis is a low-grade infection that affects the disc space between two vertebrae. Although discitis is uncommon, children under ten are usually the ones affected by this condition which is the result of an inflammation caused by staphylococcus, viruses, or other inflammatory processes. Discitis is characterized by the slow onset of severe back pain and may or may not be associated with fever, chills, sweats, feeling tired, loss of appetite or other symptoms. The diagnosis is usually made by seeing narrowing of the disc space between two vertebrae and a bone scan that shows that the disc and adjacent vertebrae are "hot" on the scan. This condition can be very painful and is often aggravated by any movement of the spine. The pain often travels to other parts of the body including the abdomen, hip, leg, or groin. It usually occurs in the lower (lumbar) back and upper (thoracic) back.


Spinal Infection
Young children with this condition are usually irritable and uncomfortable and refuse to sit up, stand or walk. The treatment of discitis generally involves antibiotics, rest, and a brace. Surgery is rarely needed.

 

Ankylosing Spondylitis
Ankylosing spondylitis is a rare condition that can cause back and neck pain. It is a rheumatic inflammatory disease that affects the spine and sacroiliac joints. Although it primarily attacks the spine (usually the low back first), this chronic and painful disease can also attack other joints, tendons and ligaments, and the chest wall.

Over time, this disease can cause the vertebral bodies in the spine to fuse together. When this happens, patients with ankylosing spondylitis can have difficulty moving freely. Common symptoms for ankylosing spondylitis are gradually occurring back pain and stiffness (usually over a period of weeks or months). Early morning stiffness is often helped with a warm shower or light exercise. Symptoms last longer than three months.

In particularly severe cases, patients may be unable to look above the level of the horizon, or they may develop a significant amount of pain from having a hunched over posture. Ankylosing spondylitis is usually diagnosed using x-rays of the sacroiliac joints, looking for changes in the tissues caused by inflammation. However, tissue changes are not always visible.

 

 


 

Tumors

Tumors of the spine and spinal cord are relatively uncommon. The most common initial symptom that patients with a spinal tumor have is pain. Because back pain is very common, it is also not a specific symptom of any one disease or medical condition. Spinal cord tumors can be either primary (originating in the spinal cord) or secondary (metastases of cancer that originated elsewhere in the body). Therefore, the challenge is to determine how to evaluate back pain with the goal of specifically excluding a tumor as the cause of the pain. Luckily, most back pain is not due to a tumor. However, if a cancer were discovered after a long period of "conservative" management of back pain, most patients would feel that their problem should have been investigated more thoroughly in the beginning.

Benign Tumors
Doctors use the term "benign" to indicate that a particular tumor is unlikely to spread to others parts of the body. Benign tumors can still be a significant problem however, depending upon their location, size, adjacent structures, blood supply, and other factors. Fortunately, most benign tumors can be treated successfully.

 

Malignant Lesions
Doctors use the term "malignant" to indicate that a particular tumor or a cancer often spreads to other parts of the body, and can be difficult to cure or treat. This is very different from "benign" cancers, which are much less likely to spread, are easier to treat and control.

 

 


 

Trauma

It is impossible to predict how badly someone's spine has been injured before a doctor has evaluated them. Therefore, everyone who is involved in an accident that could have damaged their back is treated as if they do have an injury to their spine. Most people are familiar with the "backboards" that paramedics use to transport accident victims, but they are unaware of how important these devices are in keeping the spine stable while they are taken to the hospital.

Paramedics and emergency response teams treat accident victims according to strict protocols that have been developed in order to save lives. These protocols are designed to minimize the possibility that someone with a spine injury could be injured while moving him or her from the accident scene or while taking them to a hospital. With these protocols, cervical collars are placed on all accident victims, they are secured on a back-board, and then taken to a hospital for further evaluation.

 

Spinal Cord Injuries
Each year in the United Sates, there will be approximately 50,000 new spinal cord injuries caused by accidents. A spinal cord injury occurs when the cord itself is crushed, stretched, or torn by the accident.

Unfortunately, this is still an injury that can not be reversed or cured by modern medicine. More than half of these injuries involves the cervical spine, and most of them happen to young men. These injuries are incredibly devastating to the patient, their families, and also to their communities. There is currently a lot of research being done on ways to minimize spine injuries by designing cars for better safety, improving protective gear like football helmets, and educating people about the dangers of certain activities.

There is also a lot of research being done on how to care for someone immediately after they have had a spinal cord injury, and also what kind of rehabilitation is best for them.

Osteoporosis

Osteoporosis is a disorder caused by a decrease in the amount of calcium in your bones, which can cause the bones in your spine to break because they are too weak to support the weight of the body. When this happens, people usually suffer from sharp back pain, and they often become shorter or have a "hunched over" posture. If you have these symptoms you could be suffering from osteoporosis.

Osteoporosis is a disease that affects more than eight million women and two million men. It is characterized by low bone mass and deterioration of bone tissue which can lead to fragile bones and increased risk in fractures of the spine, hip and wrist. More than 700,000 vertebral fractures every year are caused by osteoporosis.

Osteoporosis is some times called the "silent disease" because bone loss has no symptoms, and the disease usually remains painless until a bone breaks. Although the disease can affect any bone, spinal or vertebral compression fractures can have serious consequences including loss of height, severe back pain, and deformity, a curving of the shoulders and back, and a thickening waistline. Women in particular reach their maximum bone mass at about the age of 20. After that, they will gradually lose bone mass. In the 5-7 years immediately following menopause, women will lose up to 20% of their bone mass. When osteoporosis affects the spine, there is a gradual collapse of the vertebrae producing back pain, loss of overall height, and a stooped posture. The back pain at vertebral collapse may be severe at times.

 


Neck Pain

Neck pain and symptoms caused by a cervical (neck) spine disorder are a very common problem for many adult Americans. The cervical spine is composed of many different anatomic structures, including muscles, bones, ligaments, and joints. Each of these structures has nerve endings that can detect painful problems when they occur. The different parts of the cervical spine are normally well balanced and able to handle all of the movements, stresses, and strains of the body gracefully. However, when the different parts of the cervical spine are injured or start to wear out, your neck can be a significant source of pain and discomfort.

Studies show that approximately fifty percent of the population has evidence of degenerative changes in their cervical spine by the age of fifty. These changes happen because the discs that act as shock absorbers between the vertebral bodies of the cervical spine wear out, as we grow older. As the intervertebral disks wear out, they begin to collapse, or herniate, and become less flexible. The common causes of neck pain and cervical disorders include arthritis, injuries, and trauma. In some situations neck pain can also be a warning sign of something more serious such as spinal cord compression, a tumor, or spinal infection.

Any patient suffering from neck, shoulder, head or arm pain should be examined by a doctor in order to determine where the pain originates and what is causing the pain. The tissues involved in producing the pain must also be identified, and how they are being irritated must also be understood. The history of the pain and any activities that may have triggered it are also important factors in diagnosis and treatment. Impairment of movement in any part of the cervical spine can be responsible for pain, discomfort, and disability.

 

 


Mechanical Disorders

As a result of the natural wear and tear that occurs with aging, certain parts of the cervical spine start to degenerate and wear out, as we grow older. This process makes some of the anatomic structures of the cervical spine, the bones, intervertebral discs, ligaments, and muscles less flexible and less resistant to injury.

Degenerative Disc
Degenerative disc disease (DDD) is part of the natural process of growing older. Unfortunately, as we age, our intervertebral discs lose their flexibility, elasticity, and shock absorbing characteristics. The ligaments that surround the disc, called the annulus fibrosis, become brittle and they are more easily torn. At the same time, the soft gel-like center of the disc, called the nucleus pulposus, starts to dry out and shrink. Degenerative disc disease is as certain as death and taxes, and to a certain degree this process happens to everyone. However, not everyone who has degenerative changes in their cervical spine has pain. Many people who have "normal" necks have MRI's that show disc herniations, degenerative changes, and narrowed spinal canals. Every patient is different, and it is important to realize that not everyone develops symptoms as a result of degenerative disc disease.

 


Herniated Disc
There are soft-tissue discs between the bony vertebral bodies in your cervical spine that are called intervertebral discs. These discs are composed of a soft gel-like center called the nucleus pulposus, and a tough outer lining that surrounds the disc called the annulus fibrosis. The intervertebral disc creates a joint between each of the vertebral bodies that allows them to flex and extend, rotate slightly, and move with respect to one another. When the outer lining that surrounds the disc tears, the soft center squeezes out through the opening, creating a "herniated", "slipped", or "ruptured disc". Each of these terms describes the same process.


Myelopathy
Myelopathy is a term that means that there is something wrong with the spinal cord itself. This is usually a later stage of cervical spine disease, and is often first detected as difficulty walking due to generalized weakness or problems with balance and coordination. This type of process occurs most commonly in the elderly, who can have many reasons for having trouble walking or problems with gait and balance. However, one of the more worrisome reasons that these symptoms are occurring is that bone spurs and other degenerative changes in the cervical spine are squeezing the spinal cord. Myelopathy affects the entire spinal cord, and is very different from isolated points of pressure on the individual nerve roots.

 


Radiculopathy
Doctors use the term radiculopathy to specifically describe pain, and other symptoms like numbness, tingling, and weakness in your arms or legs that are caused by a problem with your nerve roots. The nerve roots are branches of the spinal cord that carry signals out the rest of the body at each level along the spine. This term comes from a combination of the Latin word radix, which means the roots of a tree, and the Latin word pathos, which means a disease. This disease is often caused by direct pressure from a herniated disc or degenerative changes in the cervical spine that cause irritation and inflammation of the nerve roots.

 


Spondylolysis
Cervical spondylolysis is a disorder that narrows the spinal canal in the neck compressing the spinal cord or spinal nerve roots. It's a fracture or defect in the pars anticulars (a portion of the bone between each of the joints of the back), allowing one vertebral body to slide forward on the next. Spondylolyosis is sometimes referred to as pars interarticularis defect. It may be unilateral or bilateral and is usually due to a developmental defect but may be secondary to a fracture. Spondylolysis affects the area of the vertebra called the pedicle. The pedicle is part of the bony ring that protects the spinal nerves, and is the portion that connects the vertebral body to the facet joints. It's a disease that often times affects middle-aged and older adults who have degenerative discs and vertebrae in their neck. When a spondylolysis is present, the back part of the vertebra and the facet joints simply are not connected to the body, except by soft tissue.


Stenosis

Stenosis is a term used to describe a narrowing of various parts of the body. Cervical stenosis is a degenerative disease where the spinal canal and neural foramina narrow and compress the spinal cord and nerve roots. Stenosis occurs when pressure increases inflaming the facet joints. The facet joints are overlapping arches that form the spinal canal. These joints are covered with cartilage and a membrane. Degenerative changes and wear and tear can cause the facet joints to inflame. This disorder is most common in people over 50 years of age. However, genetics and congenital factors may predispose a person for stenosis.

 

 


Inflammatory and Infectious Disorders

Though infections and inflammation of the cervical spine are rare, if they are neglected for a period of time, or if there is a delay in diagnosis, they can become a significant source of pain and disability. Bone and joint infections anywhere in the body can be crippling and life threatening, and infections in the cervical spine are no exception.

Ankylosing Spondylitis
Ankylosing spondylitis is a rare condition that can cause back and neck pain. It is a rheumatic inflammatory disease that affects the spine and sacroiliac joints. This disease is three times more likely to develop in men than in women and it usually occurs between the ages of 20 and 40. Although it primarily attacks the spine (usually the low back first), this chronic and painful disease can also attack other joints, tendons and ligaments, and the chest wall. Though its cause is unknown, ankylosing spondylitis tends to run in families which suggests that genetics plays a role in the development of this disease. A patient is 10 to 20 times more likely to have ankylosing spondylitis if a parent or sibling also has this condition.

Juvenile Rheumatoid Arthritis
Juvenile Rheumatoid Arthritis is a type of inflammatory arthritis that affects almost 200,000 children in the United States. JRA is a disease that causes painful, swollen, and stiff joints in children, most commonly in large joints like the knee. JRA has three well-defined subsets: a monoarticular form, which means that that the disease affects only one joint; a polyarticular form, which means that it affects many joints, and a systemic form, which means that it affects other organs in the body besides the joints. The systemic form of the disease is most often associated with high fevers and rash, in addition to arthritis. The polyarticular and systemic forms of the disease are the two types that commonly affect the cervical spine.

Rheumatoid Arthritis

Rheumatoid Arthritis is among the most debilitating forms of arthritis causing joints to ache, throb and even deform over time. The exact cause of this inflammatory condition is not known, but it is believed to be caused by an attack on the synovium (tissue that lines the joints) by the body's immune system. The upper cervical spine can be damaged by the inflammation that is caused by rheumatoid arthritis. This disease is three times more common in women than in men and usually occurs between the ages of 20 and 50. Just like the gradual destruction of other joints in the body, several joints between the base of the skull and uppermost vertebral bodies in the cervical spine are very susceptible to damage from rheumatoid arthritis.

 


Tumors

Tumors of the spine and spinal cord are relatively uncommon. The most common initial symptom that patients with a spinal tumor have is pain. Because neck pain, and pain caused by a cervical (neck) disorder is very common, it is also not a specific symptom of any one disease or medical condition. Spinal cord tumors can be either primary (originating in the spinal cord) or secondary (metastases of cancer that originated elsewhere in the body). Therefore, the challenge is to determine how to evaluate neck pain with the goal of specifically excluding a tumor as the cause of the pain. Luckily, most neck pain is not due to a tumor. However, if a cancer were discovered after a long period of "conservative" management of neck pain, most patients would feel that their problem should have been investigated more thoroughly in the beginning.

Benign Tumors
Doctors use the term "benign" to indicate that a particular tumor is unlikely to spread to others parts of the body. Benign tumors can still be a significant problem however, depending upon their location, size, adjacent structures, blood supply, and other factors. Fortunately, most benign tumors can be treated successfully.

Malignant Lesions

Doctors use the term "malignant" to indicate that a particular tumor or a cancer often spreads to other parts of the body, and can be difficult to cure or treat. This is very different from "benign" cancers, which are much less likely to spread, are easier to treat and control.


Trauma

Cervical spine injuries can occur during motor vehicle accidents, in rough contact sports, after a fall, or by hitting your head against a hard surface, such as when diving into a pool that is too shallow. These accidents can cause injuries that range from mild cases of neck pain, called whiplash, to injuries that can cause paralysis of the rest of the body below the level of injury.

Whiplash
Whiplash is the common term used for a hyperextension injury to the neck. Though the neck is a very flexible structure, it can be injured when the weight of the head exceeds the neck's ability to control its motion. The injury usually happens when the head is suddenly jerked back and forth beyond its normal limits during a car accident, rough contact sports, or a fall. This jerking motion can cause over-stretching and tearing of the neck muscles and ligaments and can cause the discs between the neck vertebrae to bulge, tear or rupture.

Disc Herniations
The discs that act as shock absorbers between the vertebral bodies of the cervical spine can be damaged during an accident. When this happens, the material in the center of the disk can be pushed out from where it normally is, a process called disk herniation. A herniated disk can put pressure on the spinal cord or nerves to the arms and legs. In situations when a disk ruptures very quickly, as in the case of an accident, then the nerve does not have any time to adjust to the increased pressure and it may stop working.

Fractures and Dislocations
Fractures and dislocations of the cervical spine demand early and accurate diagnosis so that treatment can quickly be introduced in order to produce a painless, stable neck and prevent pressure on the spinal cord and/or nerves. When the neck is injured in very violent accidents, the bones in the neck can be broken or pulled forcefully out of normal alignment. Fractures and dislocations of the cervical spine are very serious injuries because there is the potential for damage to the spinal cord if the patient is not taken care of very carefully.

Spinal Cord Injuries
Each year in the United Sates, there will be approximately 50,000 new spinal cord injuries caused by accidents. A spinal cord injury occurs when the cord itself is crushed, stretched, or torn by the accident. Unfortunately, this is still an injury that can not be reversed or cured by modern medicine. More than half of these injuries involves the cervical spine, and most of them happen to young men. These injuries are incredibly devastating to the patient, their families, and also to their communities. There is currently a lot of research being done on ways to minimize spine injuries by designing cars for better safety, improving protective gear like football helmets, and educating people about the dangers of certain activities. There is also a lot of research being done on how to care for someone immediately after they have had a spinal cord injury, and also what kind of rehabilitation is best for them.

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