Discomfort in the spine is the main reason why people seek medical help. Almost 80% of the adult population faces this problem. Back pain causes a significant degree of disability and can be a problem that lasts from childhood to adulthood.
Dorsopathy affects almost every aspect of life. Sleep is disturbed and it becomes difficult to bend, reach or turn. Difficulties arise when driving a car, walking, lifting and performing physical exercises. If you have back pain, consult a doctor immediately. The specialist will study the history, collect the history and perform the examination. If any disorders are detected, conservative or surgical treatment is prescribed.
Why does my back hurt?
The cause of dorsopathy is muscle tension and spasm. Tension can be the result of hard physical work, awkward positions, and even poor posture.
Studying the anatomy of the spine can help understand the problem at a deeper level. Main parts of the spinal column:
- The cervical is a mobile segment subject to degenerative changes. With age, pain often occurs in the so-called "transition zone" between the flexible cervical vertebrae and the more rigid thoracic spine.
- Thoracic - connected to the chest and connects to the ribs. In particular, older people can experience compression fractures in this area as a result of bone loss.
- Lumbar – lower back. Young patients are more prone to discogenic low back pain, while older patients are more likely to experience disorders of joint structures.
- Sacral – the lowest part of the spine. It consists of a flat, triangular sacrum that connects to the hips and coccyx. Degeneration of this area usually occurs in elderly patients or after a fall.
Between the upper back and coccyx are 17 vertebral bodies, many joints, the sacrum and coccyx, as well as fibrous and muscular support structures, intervertebral discs, spinal cord and nerve roots, and blood vessels. The spine is more than the sum of its parts, but here's what you need to know about those parts.
The spine usually consists of 33 vertebrae, each of which is divided by an intervertebral disc. Vertebrae are a series of small bones to which muscles are attached. Each vertebra consists of two parts: the anterior body, which protects the spinal cord and nerve roots, and the posterior arch, which houses the canal and also protects the spinal cord.
Back muscles are divided into three groups:
- middle - responsible for the movement of the ribs;
- internal – they stabilize the spinal column, control the movement and position of the spinal column;
- surface - allow movement of the neck and upper limbs.
The muscles that support the spine are structured in layers. They act as the main stabilizers of bone and ligament structures. Tensions of these muscles are possible in patients of different age groups.
There are other parts of the spine that need to be considered when determining dorsopathy. These include ligaments and tendons, intervertebral discs and joints that provide stability and mobility.
Inflammatory diseases, malignant diseases, pregnancy, trauma, osteoporosis, nerve root compression, radiculopathy, plexopathy, osteochondrosis, herniated disc, spinal stenosis, sacroiliac joint dysfunction, facet joint damage and infection are all part of the differential. Differentiating the signs and symptoms of nociceptive (mechanical) pain from radiculopathy (neuropathic dorsopathy) is an important first step in establishing a diagnosis.
Degenerative pathologies
Degeneration includes endplate-related changes (sclerosis, defects, modal changes, and osteophytes) as well as disc changes (fibrosis, annular tears, desiccation, height loss, and mucinous annular degeneration).
Degenerative disc changes are already observed in a third of healthy people between the ages of 21 and 40. The high prevalence of asymptomatic degeneration should be taken into account when evaluating spinal symptoms.
With age, the intervertebral disc becomes more fibrous and less elastic. Degenerative changes progress when the structural integrity of the posterior annulus fibrosus is compromised by overload. This will eventually lead to the formation of cracks in the annulus fibrosus. Herniation is defined as displacement of the disc material (cartilage, nucleus, fragmented annular tissue and apophyseal bone) outside the intervertebral disc space.
Rachiocampsis
The natural curves of the spine are important to ensure its strength, flexibility and ability to distribute loads evenly. There is a normal range of natural curves. Abnormal curves include lordosis, kyphosis, and scoliosis.
Abnormal lordosis
Lordosis, a spinal disorder, is defined as a severe inward curvature of the spine. Although this disease most often affects the lumbar spine, it can also develop in the cervical spine.
A normal range of lordosis is considered to be between 40 and 60 degrees. Changes in posture can lead to instability in walking and changes in the figure - the buttocks become more noticeable. Causes of abnormal lordosis: spondylolisthesis, osteoporosis and obesity.
Abnormal kyphosis
Kyphosis, a disorder of the spine, is defined as an excessive outward curvature of the spine and can result in a forward lean. It most often affects the thoracic or thoracolumbar region, but it can also occur in the cervical region.
A normal range of kyphosis is considered to be between 20 and 45 degrees. But when a structural abnormality results in the development of a kyphotic curve outside this normal range, the curvature becomes abnormal and problematic. It manifests itself by rounding the shoulders and tilting the head forward.
Scoliosis
It is defined as an abnormal lateral curvature of the spine. Scoliosis is a progressive structural disease. Lordosis and kyphosis are characterized by backward or forward curvature of the spine. Scoliosis involves an abnormal lateral curvature of the spine.
The most common form of scoliosis is adolescent scoliosis, which is diagnosed between the ages of 10 and 18. The remaining 20% is caused by neuromuscular, congenital, degenerative and traumatic causes.
Developmental anomalies
The symptom often occurs with developmental defects and can be combined with neurological manifestations.
Dorsopathy is present with the following developmental anomalies:
- Splitting – with small bone defects, moderate discomfort occurs in the lumbosacral region. After some time, radicular syndrome appears.
- Lumbarization, sacralization - root compression is accompanied by cracking or burning pain. Disorders of sensitivity or paresis may be added.
- Wedge vertebrae - discomfort occurs when straining and maintaining a static body position for a long time. Accompanied by chest deformation and poor posture.
Osteoporosis
It usually affects the thoracic and thoracolumbar spine and can cause debilitating pain. This disorder is caused by loss of bone mineral density, leading to brittle bones.
Osteoporosis can cause vertebral compression fractures, loss of height, stooped posture, and even hunchback. To prevent osteoporosis, it is necessary to ensure a balanced diet, stop smoking and abuse alcohol. An active lifestyle is also recommended.
Injuries
The severity of dorsopathy corresponds to the severity of the injury. As a rule, it is combined with signs of nerve tissue damage.
Traumatic causes of pain in the spine:
- A bruise is the result of a direct blow or a fall on the back. Dorsopathy is local, moderate. It gradually disappears over 1-2 weeks.
- Dislocation - occurs as a result of a high-energy impact. It is accompanied by severe pain combined with impaired sensitivity and motor activity. The general condition also suffers.
- Spondylolisthesis is a traumatic injury to the spine in the lumbar region. Dorsopathy radiates to the legs, there is a positive symptom of axial load.
- Compression fracture - occurs when falling on the buttocks or jumping from a height. At first, the pain is sharp, then becomes intense and progresses with movement.
Pathological fractures that occur against the background of osteoporosis or tumors are manifested by minor discomfort, nagging and aching pain. They remain unchanged for a long time.
Inflammatory and infectious diseases
Ankylosing spondylitis is accompanied by a feeling of stiffness and dull pain in the lumbar region. There is a characteristic circadian rhythm - symptoms appear at night and intensify in the morning. The intensity decreases after physical activity and water procedures. Dorsopathy increases at rest and decreases with movement. Over time, the mobility of the spine is limited and thoracic kyphosis is formed.
Also, with tuberculosis, pain occurs in the spine. Deep local discomfort is characteristic of vertebral destruction. Dorsopathy increases with exercise and is accompanied by excessive skin sensitivity. In the case of shooting and radiating pain, we are talking about compression of the nerve roots. The condition is complemented by stiffness of movement.
In osteomyelitis, intense dorsopathy is observed. The disease is diagnosed in patients in childhood and adolescence. It is characterized by hematogenous nature. Discomfort increases with movement, so the patient stays in bed. Osteomyelitis is accompanied by fever, weakness and local swelling.
Arachnoiditis is manifested by pain that radiates to the area of innervation of the nerve roots. Symptoms become permanent and resemble sciatica. They are complemented by motor disorders, sensitivity disorders and loss of pelvic organ control.
Tumors
Benign neoplasms have a hidden course or are accompanied by slowly progressive and weak symptoms. Hemangiomas appear most often, appearing only in 10-15% of cases. Discomfort is painful, local. It progresses at night and after physical activity. Spinal cord neoplasia is accompanied by radicular pain and impaired nerve conduction.
Sarcomas of the spinal column in the primary stage of progression are manifested by moderate occasional pain, which intensifies at night. Accompanied by limitation of motor activity and radicular syndrome. Discomfort is localized in internal organs, legs or arms (taking into account the level of tumor location).
Other diseases
Discomfort in the spine is also observed in:
- Spinal epidural bleeding - similar to the signs of radiculitis, accompanied by a spinal cord conduction disorder.
- Calvet's disease - radiates to the legs, appears periodically, is mildly expressed. It decreases in the lying position, increases during physical activity.
- Forestier's disease - localized in the thoracic region, spreads to the lower back or neck. Symptoms are usually short-lived. It may be accompanied by pain in the elbow or shoulder joints. Spinal stiffness cannot be ruled out.
Dorsopathy sometimes occurs in mental disorders. In this case, the clinical picture is unusual - it does not fit the symptoms of possible diseases.
Causes of back pain by location
Chronic upper back dorsopathy affects 15 to 19% of people worldwide. Postmenopausal women are at higher risk, possibly due to osteoporosis and vertebral compression fractures.
Professional activities also lead to back pain. Those who have to maintain a static body position for long periods of time, such as dentists or salespeople, are more likely to experience this problem than others. Office workers feel discomfort in the upper back due to poor workplace ergonomics.
Dorsopathy can occur at different points of the spine. The area of localization indicates the cause of the discomfort and greatly facilitates the diagnosis.
Pain on the right side
The cause is excess body weight, slipped disc or myositis. Discomfort also occurs on the right side of the back with kyphosis.
Somatic pathologies include salpingitis, ovarian inflammation, nephritis, and cholecystitis. Appendicitis and the presence of stones in the organs of the urinary system should also be emphasized.
Pain on the left side
The back on the left side hurts due to splenitis (inflammation of the spleen), urolithiasis, oophoritis, duodenitis, pinched roots. Discomfort above the lower back indicates inflammation of the serous membranes of the lungs, bronchial damage, ischemia and intercostal neuralgia.
Pain in the lumbar region
The lumbar region is more often than others susceptible to the development of pathological processes from the spinal column. This is due to the fact that it carries a colossal load. When the nerve roots are damaged, an inflammatory process develops. Hernial protrusion and osteochondrosis are also possible.
Less often, the cause is a combination of prostatitis and urethritis, violation of the structure of bone tissue, reduced density, lumbar sciatica, arthritis, tuberculosis of the spine. Discomfort in the lower back is chronic in most cases.
Pain in the lower back on the right side
Dorsopathy occurs when:
- myositis;
- tuberculosis;
- scoliosis;
- osteomyelitis;
- spondylitis.
It may indicate the presence of a neoplasm. We are talking about radiculitis. It indicates liver dysfunction.
Pain in the left lumbar region
Discomfort is localized mainly after physical activity. The condition returns to normal after rest. If the complaints do not subside at rest, then it is a matter of scoliosis, osteochondrosis, spinal infections and circulatory disorders.
A pinched nerve
In the vast majority of cases, pinching of the sciatic nerve (sciatica) occurs. At the same time, his myelin sheath is not damaged. It most often develops against the background of osteochondrosis. Accompanied by acute, severe symptoms radiating to the lower back, sacrum and lower extremities.
Spinal nerve roots are also compressed during compression radiculopathy. The cause is a herniated disc or a reduction in the distance between the vertebrae. A "superficial" discomfort is felt, which suddenly intensifies during exercise, sneezing, coughing.
Intervertebral hernia
It is characterized by the extrusion (protrusion) of the nucleus into the intervertebral canal. In most cases, it develops against the background of osteochondrosis. The central part of the extruded core compresses the spinal cord. Even a slight load leads to the progression of the pathological process. Dorsopathy is sharp and acute, spreading to the leg or arm.
Pain in shoulder blades
Based on the nature of dorsopathy, a presumptive diagnosis can be made:
- dull, growing – stomach ulcer;
- acute, aggravated with movement - intercostal neuralgia;
- numbness of hands, changes in pressure, dizziness - osteochondrosis;
- radiation under the collarbone - exacerbation of angina pectoris.
Pain along the spine and back
It develops due to pinched nerve endings against the background of curvature of the spinal column. If the symptoms are not clearly expressed, we can talk about a protrusion. Increased symptoms indicate osteochondrosis, myositis or fracture.
Severe discomfort along the spine indicates wear or thinning of the intervertebral discs. It may indicate spondyloarthritis. The pain is constant and sharp.
Pain below the waist
They most often occur in spondyloarthrosis and osteochondrosis. Less often observed in diseases of the female genital area (oophoritis, cervicitis, endometritis, etc. ). They can appear during pregnancy, during menstruation, with appendicitis, ulcerative colitis. In men, they indicate diseases of the urinary bladder or prostate.
Diagnostics
First, a physical examination is performed to identify signs that indicate the need for further testing. Medical examination includes the following procedures:
- Examination of the back and posture to determine anatomical abnormalities.
- Palpation/percussion of the spine - assessment of the condition of the spine and painful areas.
- Neurological examination - assessment of reflexes, sensitivity of the spinal column and gait characteristics. For patients suspected of having radiculopathy, the neurologic examination should focus on the L5 and S1 nerve roots.
Patients with a psychological disorder contributing to back pain may have accompanying physical signs, also known as Waddell's signs. These include the patient's overreaction during physical examination, superficial tenderness, and unexplained neurologic deficits (eg, sensory loss, sudden weakness, or jerky movements during motor examination). The presence of multiple Waddell signs indicates a psychological component of dorsopathy.
Treatment of back pain
In cases of dorsopathy, treatment should be carried out by a doctor. The specialist refers the patient to an examination and, based on the results obtained, prescribes effective therapy.
Additional therapeutic measures should be used with caution and after consultation with a doctor. Any type of medicine carries possible risks and side effects, so self-medication is not acceptable.
Help before diagnosis
Basic home remedies that can be effective in combating mild to severe pain caused by muscle tension include:
- A short period of rest. Many episodes of low back pain can be alleviated by eliminating physical activity. It is not recommended to rest for more than 2-3 days, as long-term inactivity makes healing difficult.
- Change of activity. It is recommended to remain active, but avoid activities and body positions that aggravate dorsopathy. For example, if sitting for long periods in a car or at a desk increases the discomfort, you should warm up every 20 minutes.
- Exposure to heat or cold. A heating pad or warm bath relaxes tense muscles and improves blood flow, reducing discomfort. If your lower back hurts from inflammation, you can use ice or cold compresses to reduce swelling.
The most common over-the-counter medications for dorsopathy are ibuprofen, naproxen, and acetaminophen. Medicines relieve inflammation and reduce discomfort in the lower back.
Conservative therapy
Oral drug therapy:
- Analgesics. Patients are prescribed drugs from the anilide group, such as paracetamol. It provides a long-lasting analgesic effect. They have a synergistic effect with NSAIDs and are used in combination to improve pain relief without increasing toxicity.
- Nonsteroidal anti-inflammatory drugs. They have analgesic properties. In larger doses, they have an anti-inflammatory effect.
- Muscle relaxants. They act centrally, affecting the activity of the muscle stretch reflex. The combination of an NSAID and a muscle relaxant provides significant relief from dorsopathy. The main side effects are drowsiness, headache, dizziness and dry mouth.
- Neuropathic pain relievers. Tricyclic antidepressants relieve chronic pain. Low doses may be sufficient to control symptoms. They do not work immediately and may need to be continued for several weeks before symptoms improve. It plays a potential role when discomfort is mediated by both peripheral and central mechanisms.
Local or regional anesthesia, given by injection, is part of the treatment regimen for some patients with back pain. The injection site can be an area of local injury or a myofascial trigger point (painful muscle area).
Epidural corticosteroid injections are used for radicular pain that does not respond to less invasive treatments. It is used to relieve the condition of intervertebral hernias, spinal stenosis and radiculopathy. It reduces dorsopathy and quickly restores sensory functions.
Operation
A small percentage of people with back pain require surgery to improve their condition. Indications for surgery vary depending on the patient's characteristics and include:
- severe radicular symptoms, especially in the presence of progressive neurological motor deficits;
- radicular symptoms that are not amenable to conservative treatment.
The choice of surgical intervention is determined by the characteristics of the spinal cord injury. The operation is most effective when the clinical picture in patients is dominated by manifestations of nerve compression. The most common problem is inadequate neural decompression. Associated diseases including hip arthritis, osteoporosis and cardiovascular disease.
Surgery for patients with radicular pain due to a herniated disc primarily involves decompression. Bulging, extruded or isolated disc material is removed. The nerve root is inspected and released.
Prevention
Complications are generally determined based on etiology. They are divided into physical and social. The first includes chronic pain, deformity, neurological effects with motor or sensory deficits, bowel or bladder damage. In social terms, complications are usually measured by disability and reduced performance.
Patients of all ages should:
- eliminate bad habits;
- lead an active lifestyle;
- strengthen the protective functions of the body;
- lift heavy objects properly;
- perform preventive examinations at the doctor's office.
It is important not to slouch and keep your back straight. The place to sleep and work must be properly organized. It is recommended to perform light gymnastic exercises every day after waking up. You should also balance your diet by enriching your diet with foods that contain enough vitamins and minerals. It is recommended to take a contrast shower in the morning.