Back Pain

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Causes

Many conditions can cause back and neck pain, ranging from injury to infection to simply twisting the wrong way. An injury sustained in an automobile or other type of accident can damage muscles, joints, ligaments, and vertebrae.

Overuse or underuse of the back is by far the most common cause of back pain that manifests as tightening or spasm of the muscles that connect to the spine. Inflammation and swelling often occur in the joints and ligaments, especially in the cervical and lumbar regions, as people age.

A herniated disc occurs when the inner material of the disc (nuclear pulposus), pushes through a tear in the capsule of elastic fibers that surrounds the disc (annulus fibrosus), causing nerve root compression.

The cervical and lumbar regions of the spine have the most mobility and the discs there are more likely to wear down or be injured. Ninety percent of disc herniations occur in the lower two lumbar vertebrae.

Over time, repeated daily stress coupled with minor injury can contribute to intervertebral disc degeneration. The annulus fibrosus, the capsule of elastic fibers that surrounds the disc, may develop small tears and form scar tissue.

As more scar tissue forms, the nucleus pulposus, the semifluid inner portion of the disc, begins to dry up. Over time, the disc collapses and significantly narrows the space between vertebrae, causing spinal stenosis.

Spinal stenosis, narrowing of the spine, can cause spinal cord irritation and injury. Conditions that cause spinal stenosis include infection, tumors, trauma, herniated disc, arthritis, thickening of ligaments, growth of bone spurs, and disc degeneration. Spinal stenosis most commonly occurs in older individuals as a result of vertebral degeneration.

A pinched nerve, or radiculopathy, occurs when something rubs or presses against a nerve, creating irritation or inflammation. Radiculopathy can result from a herniated disc, bone spur, tumor growing into the nerves, and vertebral fracture, and many other conditions.

Sciatica is a certain type of radiculopathy that involves inflammation of the sciatic nerve. Pain is experienced along the large sciatic nerve, from the lower back down through the buttocks and along the back of the leg.

A spinal tumor that originates in the spine (primary tumor) or spreads to the spine from another part of the body (metastatic tumor) can compress the spine or nerve roots and cause significant pain.

An infection that develops in the vertebrae (e.g., vertebral osteomyelitis), the discs, the meninges (e.g., spinal meningitis), or the cerebrospinal fluid can compress the spinal cord and result in serious neurological deterioration, if it is not diagnosed and treated immediately.

Facet joints allow movement of the spine. These consist of two knobs, or facets, that meet between each vertebra to form a joint. As facet joints degenerate, they may not align correctly, and the cartilage and fluid that lubricates the joints may deteriorate. Bone then rubs against bone, which can be very painful.

Bone and joint diseases (e.g., osteoporosis, ankylosing spondylitis, osteoarthritis) can cause degeneration, inflammation, and spinal nerve compression.

Pain can radiate to the back from other areas of the body (i.e., referred pain) affected by disease or injury, such as bleeding from the aorta, the large artery that carries blood out of the heart; pancreatic disease; pneumonia; kidney diseases; bladder disorders; and uterine abnormalities.

Back Pain, Causes reprinted with permission from neurologychannel.com
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