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Anatomy of the Back

Facet Joint AnatomyThe back is a complex structure consisting of:

  • 24 small bones (vertebrae)
  • Shock absorbing discs (intervertebral discs) that cushion the bones and allow the spine to bend
  • Ligaments to hold vertebrae and discs together
  • Tendons to connect muscles to vertebrae
  • Spinal cord (carries nerves from the brain to the rest of the body)
  • Nerves
  • Muscles

Back pain is a common problem which affects 4 out of 5 of us at some point. It’s often caused by a simple muscle, tendon or ligament strain and not usually by a serious problem.

During the course of this year, 16.5 million people in the United Kingdom will rely on drugs, physical therapy, the scalpel, or any number of medical procedures, to manage their back pain.

Back pain can be acute, where the pain starts quickly but then reduces after a few days or weeks, or chronic, where pain might last on and off for several weeks or even months and years.

In a typical National Health Service year up to 7 million patients will consult a GP because of back pain. Of these, 1.6 million will be referred to consultants in hospital out-patient departments, and 100,000 of these referrals will be admitted to hospital. Just under a quarter of the referrals, around 24,000 patients, will have surgery to treat their back pain.

The symptoms of simple back pain often occur suddenly and can be triggered by a particular movement, but the causes may have been building for some time. Today 1.3 million new people in the UK are wondering what’s wrong with them and if they will ever be pain-free again. There is good news: these days there are options starting with the services of Healthplus Clinics.

 

Symptoms of Back Injury

The location and severity of back pain may vary, depending on the cause of the problem. Signs and symptoms that sometimes accompany back pain include:

  • Pain in back or legs
  • Swelling and stiffness
  • Redness and warmth to the touch
  • Weakness or instability
  • Popping or crunching noises
  • Inability to fully move the back
  • Pins and needles
  • Numbness
  • Inability to weight bear on the legs

For patients suffering from back pain, the first step to recovery is to receive a proper diagnosis so the cause of the symptoms can be determined.

If you feel you have a potential infection in the back or a fracture, urgent medical attention should be sought.

Cauda equina syndrome – rare, but an emergency

Cauda equina syndrome is a particularly serious type of nerve root problem. This is a rare disorder where the nerves at the very bottom of the spinal cord are pressed on. This syndrome can cause low back pain plus: problems with bowel and bladder function (usually unable to pass urine), numbness in the saddle area (around the anus), and weakness in one or both legs. This syndrome needs urgent treatment to preserve the nerves to the bladder and bowel from becoming permanently damaged. Go to A and E immediately if you suspect cauda equina syndrome.

Causes of Back Pain

Some of the most common causes of stress and strain on the spine include:

  • Poor posture – slouching in chairs, driving in hunched positions and standing badly
  • Lifting incorrectly
  • Sleeping on sagging mattresses
  • Being unfit
  • Generally overdoing it – over tiring muscles and not using a gradually increasing work or sports programme. Not warming up or cooling down before and after exercise will also cause muscle pain
  • Inactivity and the wrong sort of movement are usually at the root of simple back pain.

Inactivity makes the muscles go slack and weak so they are unable to support the back properly. This leaves the back more vulnerable to damage when certain movements put too much strain on one area.

Often, the problem is caused by a strain or tear to the muscles, tendons or ligaments around the lower spine. In turn, this can produce painful muscle tension and spasm.

Even a minor problem can cause a lot of pain when you stand, bend or move around. Pain sometimes comes on suddenly, sometimes gradually, but usually it only lasts a few days or up to a week.

Non-specific low back pain

This is the most common type of back pain. About 19 in 20 cases of acute (sudden onset) low back pain are classed as non-specific. This is the type of back pain that most people will have at some point in their life. It is called non-specific because it is usually not clear what is actually causing the pain.

It is thought that in some cases the cause may be a sprain (an over-stretch) of a ligament or muscle. In other cases the cause may be a minor problem with a disc between two vertebrae, or a minor problem with a small facet joint between two vertebrae. There may be other minor problems in the structures and tissues of the lower back that result in pain. However, these causes of the pain are impossible to prove by tests.

Nerve root pain – often called sciatica

This occurs in less than 1 in 20 cases of acute low back pain. Nerve root pain means that a nerve coming out from the spinal cord (the root of the nerve) is irritated or pressed on. Many people call this pressure a trapped nerve. You feel pain along the course of the nerve. Therefore, you typically feel pain down a leg, sometimes as far as to the calf or foot. The pain in the leg or foot is often worse than the pain in the back. The irritation or pressure on the nerve may also cause pins and needles, numbness or weakness in part of a buttock, leg or foot.

About 9 in 10 cases of nerve root back pain are due to a prolapsed disc – often called a slipped disc. A disc does not actually slip. What happens is that part of the inner softer part of the disc bulges out (prolapses) through a weakness in the outer harder part of the disc. The prolapsed part of the disc can press on a nerve nearby. Other less common conditions can cause pressure on a nerve to cause nerve root pain for example piriformis syndrome.

Cauda equina syndrome – rare, but an emergency

Cauda equina syndrome is a particularly serious type of nerve root problem. This is a rare disorder where the nerves at the very bottom of the spinal cord are pressed on. This syndrome can cause low back pain plus: problems with bowel and bladder function (usually unable to pass urine), numbness in the saddle area (around the anus), and weakness in one or both legs. This syndrome needs urgent treatment to preserve the nerves to the bladder and bowel from becoming permanently damaged. Go to A and E immediately if you suspect cauda equina syndrome.

Serious Symptoms in Back Pain

There are several warning signs, known as red flag signs, that may indicate that your back pain is caused by a more serious condition that requires immediate medical help. These include:

  • a fever of 38ºC (100.4ºF) or above
  • unexplained weight loss
  • swelling of the back
  • constant back pain that does not ease after lying down
  • pain in your chest or high up in your back
  • pain down your legs and below the knees
  • pain caused by a recent trauma or injury to your back
  • loss of bladder control
  • inability to pass urine
  • loss of bowel control
  • numbness around your genitals, buttocks or back passage
  • pain that is worse at night
Investigations for Back Pain and Injury

Like every joint evaluation, the start to a diagnosis is a consultation followed by a physical examination. Your specialist will inspect your back for swelling, pain, tenderness, warmth and visible bruising. A visual assessment is followed by evaluation of the movement and specific orthopaedic tests to determine integrity.

After a provisional diagnosis is made by your specialist, it may be suggested you have the joint imaged by:

  • X-ray
  • MRI Scan
  • CT Scan
  • SPECT CT Scan
  • Ultrasound

If your specialist suspects an infection or arthritis you may be recommended a series of have blood tests .

On rare occasions your specialist may request a nerve conduction study to look for nerve injury and compression.

Treatment of Back Pain

Throughout your diagnosis, treatment, and rehabilitation, dedicated team members will continue to work hard to ensure you can get back to enjoying life with the most comfort, mobility, and functionality possible.

Healthplus Clinics has assembled a group of Back Pain Specialists to provide complete surgical and non-surgical treatments. Our team of Spinal Specialists includes: Spinal Surgeons, Neurosurgeons, Pain Specialists, Podiatrists, and specially trained Back Pain Physiotherapists, Chiropractors, and Osteopaths.

Non-Surgical Back Treatments and Procedures

  • Specialist Back Pain Physiotherapy
  • Osteopaths
  • Chiropractors
  • Gait Analysis and Biomechanical Examination
  • Orthotics Prescription
  • Shockwave Therapy
  • Back Pain and Spinal Acupuncture
  • Electrotherapy

Spinal Pain Management Procedures

  • Lumbar facet joint injections
  • Lumbar medial branch blocks
  • Lumbar medial branch radiofrequency neurotomy (facet joint denervation)
  • Sacroiliac joint injection
  • Sacroiliac joint denervation
  • Lumbar/sacral transforaminal epidural steroid injection
  • Lumbar/sacral dorsal root ganglion pulsed radiofrequency
  • Lumbar sympathetic block
  • Lumbar chemical sympathectomy
  • Piriformis block

Surgical Spinal Treatments and Procedures

  • Disc replacement
  • Discectomy
  • Foraminotomy
  • Gamma knife procedures
  • Interlaminar replacement
  • Kyphoplasty or Vertebroplasty
  • Laminectomy
  • Laser spine surgery
  • Lumbar descompression
  • Micro-discectomy
  • Mini open cervical fusion
  • Percutaneous screw fixation
  • Spinal fusion
  • Spinal stenosis surgery
  • Transforaminal endoscopy
Complications of Back Pain and Injury

Disability
Back pain is the most common cause of absence from work due to disability, and a source of high health care expenses.

It is the most common reason for disability in working adults resulting in sick leave.  Back pain limits mobility and range of motion required for standing, bending and sitting.

Nerve Damage
If the back pain results from a slipped or herniated disc, this may irritate, compress and damage the spinal nerve as it passes through the nerve canal between the vertebrae.

This can result in a variety of complications such as weakness and numbness in the leg and severe shooting pain traveling from the back to the leg at one side of the body due to sciatica.

When the sciatic nerve is compressed or damaged it may cause symptoms in the leg. In severe cases, nerve damage can also cause problems in bladder and bowel or intestinal functions.

The overwhelming majority of people who undergo back surgery have no complications during or after surgery.

All surgeries, though, carry some degree of risk. The general risks of any back surgery can include:

  • Reaction to anesthesia or other drugs
  • Bleeding
  • Infection
  • Blood clots, for instance in the legs or lungs
  • Heart attack
  • Stroke
  • Recurrent disc herniation
  • Nerve damage, which can result in weakness, paralysis, pain, sexual dysfunction, or loss of bowel or bladder control

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