Back pain can be caused by multiple injuries and or accidents. There are two types of back injury: spondylolisthesis and cervical radiculopathy. They both have their own varieties of symptoms, causes and treatments.
Our backbone is a column of 33 bones and tissue from the skull to the pelvis. These are the vertebrae that enclose and protect a cylinder of nerve tissue (known as the spinal cord). An intervertebral disk or band of cartilage lies between each vertebra, doing the job as a shock absorber between the vertebrae. The types of vertebrae are:
- Cervical vertebrae: the seven bones comprising the upper region of the spine
- Thoracic vertebrae: the 12 bones between the lower back and the neck
- Lumbar vertebrae: the five largest and strongest vertebrae of the spine, between the chest and hips.
The base of the spine (or the sacrum and coccyx). The sacrum is therefore made by five vertebrae fused together and the coccyx formed by four fused vertebrae.
What Causes Back Pain?
It can be a complex cause of back pain. Back pain may be caused by accidents, muscle strain, sports injuries, or some combination of the three.
How Is Back Pain Diagnosed?
In addition to performing a complete history and physical exam for your back pain, your doctor may suggest one of the following diagnostic studies:
- This provides detail of the bone structures in the spine and check for instability (such as spondylolisthesis, see below), tumors, and fractures via x rays.
- There are CT scans which can actually show or identify the specific condition such as a herniated disc or spinal stenosis.
- Details about the backs’ discs and nerve roots can be given through MRI scans. Most common application for pre-surgical planning is MRI scans.
In addition, other imaging and electrical studies may be done to identify back problems, as may be injections for diagnostic rather than for pain relief.
Types of Back Injury
Two main types of back injury include:
Spondylolisthesis: Most of the time, this is a slipping of vertebra at the base of the spine. This vertebral slipping backward, forward, or over the bone below is caused by a defect or fracture of one or both wing shaped parts of a vertebra, known as spondylolysis.
Cervical Radiculopathy: Cervical radiculopathy is damage or disturbance of nerve function due to compression of one or more of the nerve roots immediately caudad (below) to the cervical vertebrae. Wherever the damaged roots are, this type of damage can produce pain, weakness and loss of sensation in the neck, arms or shoulders.
Causes of Spondylolithesis
Spondylolithesis causes are many. If a person is born with a vertebra that is defective, or a vertebra is broken by trauma, or a stress fracture, that vertebra might never function well. Also, infection or disease can break down vertebrae.
Symptoms of Spondylolithesis
Symptoms of spondylolithesis may include:
- Lower back pain
- Muscle tight ness and stiffness
- Pain in the buttocks
- Pressure on nerve roots causing pain that radiates down the legs.
- Muscle weakness
Spondylolithesis Treatments
Physical therapy, the strengthening of supportive abdominal and back muscles, is the treatment for spondylolisthesis. Helping with pain may be acetaminophen or nonsteroidal anti-inflammatory medicine such as ketoprofen (Frotek), ibuprofen (Motrin, Advil), and naproxen (Aleve, Naprosyn). Epideal steroid injections may also help. However, for patients whose pain and disability continue to be severe these include decompressive laminectomy where the spinal canal is widened to accommodate nerves and spinal cord, either with or without surgical fusion of the vertebrae or an implanted device which stabilizes the vertebrae of the lower back while still permitting more normal movement.
What Causes Cervical Radiculopathy?
Cervical radiculopathy damage can be caused by pressure placed by material from a ruptured disc, degenerative changes in bones, arthritis or other injuries involved in the compression of the nerve roots. Normal degenerative changes in the discs can cause pressure on the nerve roots in older people. Cervical radiculopathy by rupture disc is most seen in younger people. Then, this disc material compresses the nerve root, causing pain.
The symptoms of Cervical Radiculopathy
Pain spreading into the arm, neck, chest and/or shoulders is the main symptom of cervical radiculopathy. With radiculopathy, a person may have muscle weakness or numbness or tingling in fingers or hands. Other symptoms may include lack of coordination especially in the hands.
Salmon, 2005) in men and women ranging in age from 18 years to 92 years.
A combination of pain medication and physical therapy options may include cervical radiculopathy: acetaminophen (Tylenol), or a nonsteroidal pain medication such as ibuprofen (Advil, Motrin), ketoprofen (Frotek), naproxen (Aleve, Naprosyn). Orally or epidurally injected, steroids may be prescribed.
Gentle cervical traction and mobilization, exercise and other modalities may be part of physical therapy offered to help decrease pain.
If any significant compression of the nerve leads to motor weakness surgery might be necessary to relieve that pressure.