Back injuries result from damage, wear, or trauma to the bones, muscles, or other tissues of the back. Common back injuries include sprains and strains, herniated discs, and fractured vertebrae. [1] The lumbar spine is often the site of back pain. The area is susceptible because of its flexibility and the amount of body weight it regularly bears. [2] It is estimated that low-back pain may affect as much as 80 to 90 percent of the general population in the United States. [3]
Muscle and soft tissue injuries can be classified using a graded system. [4]
Spinal column or vertebral injuries can be classified using the AO spine injury classification system. [5] The three categories - A, B, and C - are based on the location of damage on the vertebra (either on the anterior or posterior segment) and by the direction of the applied injurious force.
This classification system can be used to classify injury to the cervical, thoracolumbar, and sacral regions of the spinal column.
Herniated discs can be graded based on the size and location of the herniation as seen on an MRI.
The size of the herniation is the extent to which it protrudes into the vertebral foramen. The MSU Classification for herniated discs uses the proximity of the disc to the facet joint when measuring the size of a herniated disc. [7] Using the MSU Classification, a grade of 1, 2 or 3 can be used to describe the size of a herniated disc with 1 being the least severe and 3 being the most severe.
The location of the herniation can also be described using the MSU Classification for herniated discs. This classification describes how far away from mid-line a disc protrusion is using a grade of A, B, or C. [7]
MSU Classification is primarily used for classifying herniated discs in the lumbar spine.
Many back injuries share similar causes. Strains and sprains to the back muscles can be caused by improper movements while lifting heavy loads, overuse of a muscle, sudden forceful movements, or direct trauma. [8] Herniated discs are associated with age-related degeneration, trauma such as a fall or car accident, and bending or twisting while lifting heavy weights. [9] Common causes of vertebral fractures include trauma from a direct blow, a compression force resulting in improper or excessive axial loading, and hyper-flexion or hyper-extension. [10]
Vertebral fractures in children or elderly individuals can be related to the development or health of their spine. The most common vertebral fracture in children is spondylolysis which can progress to spondylolisthesis. [11] The immature skeleton contains growth plates which have not yet completely ossified into stronger mature bone. [11] Vertebral fractures in elderly individuals are exacerbated by weakening of the skeleton associated with osteoporosis. [12] [13]
Diagnosis of a back injury begins with a physical examination and thorough medical history by health-care personnel. [8] [14] Some injuries, such as sprains and strains or herniated discs, can be diagnosed in this manner. To confirm these diagnoses, or to rule out other injuries or pathology, imaging of the injured region can be ordered. X-rays are often used to visualize pathology of bones and can be ordered when a vertebral fracture is suspected. [15] [8] CT scans produce higher resolution images when compared to x-rays and can be used to view more subtle fractures which may otherwise go undetected on x-ray. [16] MRI is commonly referred to as the gold standard for visualizing soft tissue and can be used to assist with diagnosing many back injuries, including herniated discs and neurological disorders, bleeding, and edema. [16] [17]
Suggestions for preventing various back injuries primarily address the causes of those injuries. The risk for back sprains and strains may be reduced with lifestyle choices, including smoking cessation, limiting alcohol, maintaining a healthy weight, and keeping bones and muscles strong with adequate exercise and a healthy diet. [8] The risk for disc herniations can be reduced by using proper techniques when lifting heavy loads, smoking cessation, and weight loss to reduce the load placed on the spine. [8] [9] [18] Vertebral fractures may be difficult to prevent since common causes are related to accidents or age-related degeneration associated with osteoporosis. Treating osteoporosis with pharmacotherapy, enrolling in a fall prevention program, strengthening muscles and bones with a weight-bearing exercise program, and adopting a nutritional program that promotes bone health are all options to reduce the risk of vertebral fractures associated with osteoporosis. [13] [12]
Treatment for back injuries depends on the diagnosis, level of pain, and whether there is loss of function or quality of life.
Surgery is considered when symptoms persist after attempting conservative treatment. It is estimated 10-20 percent of individuals with low back pain fail to improve with conservative measures. [22]
Lumbar disc disease is the drying out of the spongy interior matrix of an intervertebral disc in the spine. Many physicians and patients use the term lumbar disc disease to encompass several different causes of back pain or sciatica. In this article, the term is used to describe a lumbar herniated disc. It is thought that lumbar disc disease causes about one-third of all back pain.
Back pain is pain felt in the back. It may be classified as neck pain (cervical), middle back pain (thoracic), lower back pain (lumbar) or coccydynia based on the segment affected. The lumbar area is the most common area affected. An episode of back pain may be acute, subacute or chronic depending on the duration. The pain may be characterized as a dull ache, shooting or piercing pain or a burning sensation. Discomfort can radiate to the arms and hands as well as the legs or feet, and may include numbness or weakness in the legs and arms.
An intervertebral disc lies between adjacent vertebrae in the vertebral column. Each disc forms a fibrocartilaginous joint, to allow slight movement of the vertebrae, to act as a ligament to hold the vertebrae together, and to function as a shock absorber for the spine.
Sciatica is pain going down the leg from the lower back. This pain may go down the back, outside, or front of the leg. Onset is often sudden following activities like heavy lifting, though gradual onset may also occur. The pain is often described as shooting. Typically, symptoms are only on one side of the body. Certain causes, however, may result in pain on both sides. Lower back pain is sometimes present. Weakness or numbness may occur in various parts of the affected leg and foot.
A discectomy is the surgical removal of abnormal disc material that presses on a nerve root or the spinal cord. The procedure involves removing a portion of an intervertebral disc, which causes pain, weakness or numbness by stressing the spinal cord or radiating nerves. The traditional open discectomy, or Love's technique, was published by Ross and Love in 1971. Advances have produced visualization improvements to traditional discectomy procedures, or endoscopic discectomy. In conjunction with the traditional discectomy or microdiscectomy, a laminotomy is often involved to permit access to the intervertebral disc. Laminotomy means a significant amount of typically normal bone is removed from the vertebra, allowing the surgeon to better see and access the area of disc herniation.
Low back pain (LBP) or lumbago is a common disorder involving the muscles, nerves, and bones of the back, in between the lower edge of the ribs and the lower fold of the buttocks. Pain can vary from a dull constant ache to a sudden sharp feeling. Low back pain may be classified by duration as acute, sub-chronic, or chronic. The condition may be further classified by the underlying cause as either mechanical, non-mechanical, or referred pain. The symptoms of low back pain usually improve within a few weeks from the time they start, with 40–90% of people recovered by six weeks.
A laminectomy is a surgical procedure that removes a portion of a vertebra called the lamina, which is the roof of the spinal canal. It is a major spine operation with residual scar tissue and may result in postlaminectomy syndrome. Depending on the problem, more conservative treatments may be viable.
Spondylosis is the degeneration of the vertebral column from any cause. In the more narrow sense it refers to spinal osteoarthritis, the age-related wear and tear of the spinal column, which is the most common cause of spondylosis. The degenerative process in osteoarthritis chiefly affects the vertebral bodies, the neural foramina and the facet joints. If severe, it may cause pressure on the spinal cord or nerve roots with subsequent sensory or motor disturbances, such as pain, paresthesia, imbalance, and muscle weakness in the limbs.
Degenerative disc disease (DDD) is a medical condition typically brought on by the normal aging process in which there are anatomic changes and possibly a loss of function of one or more intervertebral discs of the spine. DDD can take place with or without symptoms, but is typically identified once symptoms arise. The root cause is thought to be loss of soluble proteins within the fluid contained in the disc with resultant reduction of the oncotic pressure, which in turn causes loss of fluid volume. Normal downward forces cause the affected disc to lose height, and the distance between vertebrae is reduced. The anulus fibrosus, the tough outer layers of a disc, also weakens. This loss of height causes laxity of the longitudinal ligaments, which may allow anterior, posterior, or lateral shifting of the vertebral bodies, causing facet joint malalignment and arthritis; scoliosis; cervical hyperlordosis; thoracic hyperkyphosis; lumbar hyperlordosis; narrowing of the space available for the spinal tract within the vertebra ; or narrowing of the space through which a spinal nerve exits with resultant inflammation and impingement of a spinal nerve, causing a radiculopathy.
Spondylolisthesis is the displacement of one spinal vertebra compared to another. While some medical dictionaries define spondylolisthesis specifically as the forward or anterior displacement of a vertebra over the vertebra inferior to it, it is often defined in medical textbooks as displacement in any direction. Spondylolisthesis is graded based upon the degree of slippage of one vertebral body relative to the subsequent adjacent vertebral body. Spondylolisthesis is classified as one of the six major etiologies: degenerative, traumatic, dysplastic, isthmic, pathologic, or post-surgical. Spondylolisthesis most commonly occurs in the lumbar spine, primarily at the L5-S1 level with the L5 vertebral body anteriorly translating over the S1 vertebral body.
Cauda equina syndrome (CES) is a condition that occurs when the bundle of nerves below the end of the spinal cord known as the cauda equina is damaged. Signs and symptoms include low back pain, pain that radiates down the leg, numbness around the anus, and loss of bowel or bladder control. Onset may be rapid or gradual.
Traction is a set of mechanisms for straightening broken bones or relieving pressure on the spine and skeletal system. There are two types of traction: skin traction and skeletal traction. They are used in orthopedic medicine.
Middle back pain, also known as thoracic back pain, is back pain that is felt in the region of the thoracic vertebrae, which are between the bottom of the neck and top of the lumbar spine. It has a number of potential causes, ranging from muscle strain to collapse of a vertebra or rare serious diseases. The upper spine is very strong and stable to support the weight of the upper body, as well as to anchor the rib cage which provides a cavity to allow the heart and lungs to function and protect them.
Failed back syndrome or post-laminectomy syndrome is a condition characterized by chronic pain following back surgeries. Many factors can contribute to the onset or development of FBS, including residual or recurrent spinal disc herniation, persistent post-operative pressure on a spinal nerve, altered joint mobility, joint hypermobility with instability, scar tissue (fibrosis), depression, anxiety, sleeplessness, spinal muscular deconditioning and even Cutibacterium acnes infection. An individual may be predisposed to the development of FBS due to systemic disorders such as diabetes, autoimmune disease and peripheral blood vessels (vascular) disease.
Spinal disc herniation is an injury to the cushioning and connective tissue between vertebrae, usually caused by excessive strain or trauma to the spine. It may result in back pain, pain or sensation in different parts of the body, and physical disability. The most conclusive diagnostic tool for disc herniation is MRI, and treatment may range from painkillers to surgery. Protection from disc herniation is best provided by core strength and an awareness of body mechanics including posture.
A laminotomy is an orthopaedic neurosurgical procedure that removes part of the lamina of a vertebral arch in order to relieve pressure in the vertebral canal. A laminotomy is less invasive than conventional vertebral column surgery techniques, such as laminectomy because it leaves more ligaments and muscles attached to the vertebral column intact and it requires removing less bone from the vertebra. As a result, laminotomies typically have a faster recovery time and result in fewer postoperative complications. Nevertheless, possible risks can occur during or after the procedure like infection, hematomas, and dural tears. Laminotomies are commonly performed as treatment for lumbar spinal stenosis and herniated disks. MRI and CT scans are often used pre- and post surgery to determine if the procedure was successful.
Spinal stenosis is an abnormal narrowing of the spinal canal or neural foramen that results in pressure on the spinal cord or nerve roots. Symptoms may include pain, numbness, or weakness in the arms or legs. Symptoms are typically gradual in onset and improve with leaning forward. Severe symptoms may include loss of bladder control, loss of bowel control, or sexual dysfunction.
The TESSYS method is a minimally-invasive, endoscopic spinal procedure for the treatment of a herniated disc. It was a further development of the YESS method by the Dutch Dr Thomas Hoogland in the Alpha Klinik in Munich in 1989 and was first called THESSYS. The procedure involves performing a small foramenotomy and removal of soft tissue compressing the nerve root.
Modic changes are pathological changes in the bones of the spine, the vertebrae. These changes are situated in both the body of the vertebrae and in the end plate of the neighboring disc. Clinically, Modic Changes are often associated with constant lower back pain during the day, with peak pain occurring during the night and in the morning, coupled with back stiffness.
Astronauts have expressed an increased incidence of back pain during spaceflight and herniated intervertebral discs (IVD) have been diagnosed upon return of Skylab and Shuttle spaceflight participants.