Back Pain and Spinal Conditions
Elizabeth had pain from sciatica that was so bad she called 9-1-1 because she
couldn't walk from the living room to the bathroom. Terry had such severe pain
from spinal stenosis that she could barely walk her dog one block. Ed has had
lower back pain off and on all his adult life.
According to the National Institute of Arthritis and Musculoskeletal and Skin
Diseases, back pain is one of society's most common medical problems, affecting
8 out of 10 people at some point in their lives.
Spinal stenosis: a common cause of back pain
Arthritis is the most common cause of a very common disorder called spinal
stenosis, which occurs when the passageways of the spinal nerves become narrowed.
Spinal stenosis is most common in people older than 50, although it can affect
younger people as well.
The spine is a column containing 26 bones. Twenty four of those bones are vertebrae,
and the other two are fused vertebrae that form what's called the sacrum, in
the hip region, and the coccyx, at the base of the spine. The vertebrae are
linked by joints that stabilize the spine and give it flexibility. There are
disks between the vertebrae. These disks have a jelly-ish substance in their
centers, and they provide the cushioning between the vertebrae.
The spinal cord itself goes from the base of the brain to the lower back. It
passes through a bony channel called the spinal canal. If the channel for the
spinal cord becomes narrowed, pressure on the nerves in the spinal cord cause
pain, cramps, tingling or numbness. Arthritis can be a cause of this narrowing.
Arthritis can also cause the spinal disks to deteriorate and lose their protective
cushion. They become flat, and the jelly-type substance inside them may leak
out and press on nerves in the spinal cord. This is called a herniated disk.
Ligaments in the spine may also deteriorate with age, narrowing the spinal canal
as well and pressing on nerves.
All of this contributes to the condition known as spinal stenosis. It can be
extremely painful, although there are some people who have the condition who
don't feel very much pain at all. The pain of spinal stenosis can come and go.
Symptoms of spinal stenosis
Spinal stenosis causes the following symptoms:Pain or cramps in the legs, especially when you stand for a long period
of time or when you walk
Sciatica, which is pain that starts in the back and hip and radiates
down to the buttock and the back of the leg
Shoulder and neck pain
Headaches or loss of balance
Loss of bladder or bowel control
How is spinal stenosis treated?
Spinal stenosis is generally diagnosed with tests such as X-rays of the spine,
CT scans, CT myelograms, bone scans, and sometimes an MRI.
Most of the time, doctors prefer to treat spinal stenosis in non-surgical ways
that can include over-the-counter or prescription painkillers. If the symptoms
are severe enough, doctors sometimes inject a corticosteroid into the spinal
fluid. This can reduce inflammation and relieve the pain of sciatica.
For people who are very old, who have very weak abdominal muscles or who have
stenosis in more than one area of the spine, doctors may recommend a back brace.
Physical therapy can help relieve existing symptoms and reduce the likelihood
that symptoms will return. The physical therapist can teach you how to increase
your strength and flexibility and what to do if symptoms come back.
When should you see a doctor for back pain?
In many cases, back pain goes away on its own, but you should visit your doctor
if you have the following symptoms:
Numbness or tingling
Severe pain that doesn't improve with rest and medication
Pain that occurs from an injury or fall
Weakness, pain or numbness in your legs
Unintentional weight loss
In the case of spinal stenosis, back pain is likely to be severe enough to
warrant a visit to your doctor.
What puts you at higher risk for back problems?
Age. Back pain is more common with age, and it usually first occurs
between the ages of 30 and 40.
Fitness level. The more physically fit you are, the less likely you are
to have back pain. A regular exercise routine can strengthen the muscles in
your back and abdomen, which can help support your spine.
Healthy diet. If you're overweight, there's more stress on your back.
Job-related issues: Heavy lifting, pushing or pulling can increase the
risk of back injury, and so can a desk job, especially if you sit in an uncomfortable
chair that offers little back support.
Smoking. Smoking isn't a direct cause of back pain, but it can make it
more difficult for the body to deliver nutrients to the discs of your spine.
Additionally, repeated coughing due to smoking can cause back pain.
What about scoliosis?
Scoliosis is a different type of condition altogether. It occurs when the
spine curves abnormally to the side. The most common type of scoliosis is
called "idiopathic" scoliosis. Most of these cases occur in girls.
Parents or pediatricians often first notice scoliosis when the child has
one shoulder that looks higher than the other or when the pelvis looks tilted.
Scoliosis ranges from a slight curvature that doesn't have serious health
consequences at all, to severe curvature that can cause pain, difficulty breathing
and, if uncorrected, can lead to extreme posture problems.
How is scoliosis treated?
Treatment depends on the size and location of the curve, the severity of
the curve and the amount of growing the patient has to do.
If the curve of the scoliosis is 20 degrees or less, generally no treatment
is needed, but the patient should be monitored every six months. If the curve
gets worse-about 25 to 30 degrees-it may become necessary for the child to
wear a brace to correct the problem.
Curvatures of 40 degrees or more generally require surgery. They are likely
to get worse even after the child stops growing. Typically, the surgeon corrects
the curve and then holds the bones in place with one or two metal rods that
keep the spine from further curvature.
Teenagers who have severe scoliosis can often benefit from emotional support
and sometimes counseling.
The American Academy of Family Physicians; The American Academy of Orthopedic Surgeons; The National Institute of Arthritis and Musculoskeletal and Skin Diseases