Back Pain

An overview of back pain including anatomy of the spine, sinister and common causes.

 

Lecture by

Video Duration: 17 minutes

  • Herniated Disc
    Created by Ben Palley
    General
    Epidemiology
    • Focal extrusion of an intervertebral disc
    • Affects 3-5% of population, equally men and women
    Pathology
    • Disc dehydration and collapse
    • Herniation of the soft disc center
    • Tear of the fibrous disc ring
    Top three causes
    • Lifting heavy objects
    • Fall
    • Degenerative disc disease
    Clinical Features
    Symptoms

    GENERAL:

    • Pain in the lower back (may be absent)

    SPECIFIC:

    • Pain in a buttock, back of a thigh and eventually in a calf or foot, usually only on one side (sciatic pain)
    • Tingling or numbness in the lower leg
    • Muscle weakness in a leg
    • Symptoms are aggravated by sitting, bending and lifting objects
    • Symptoms are relieved by walking

    Detailed description of symptoms of pinched nerves

    Signs

    GENERAL signs:

    • Tenderness and muscle knots on either side of the lumbar spine
    • Decreased range of motion during passive movements of the affected leg in the hip
    • Normal sensitivity of a leg (in most cases)

    SPECIFIC signs:

    • Pain in a buttock and back of the thigh during straight leg raise test
    Investigations
    Cultures

    None

    Bloods
    • Rheumatoid factor and antinuclear antibodies (to exclude autoimmune disorders, such as rheumatoid arthritis or ankylosing spondylitis)
    • Total blood count (when a cancer is suspected)
    Imaging
    • X-ray (to exclude fractures or tumors)
    • Magnetic resonance imaging (MRI) (to locate a herniated disc when a surgery is considered)
    Scopic/Biopsy

    None

    Functional
    • Discography (to determine if pain arises from a pinched nerve or a disc itself)
    Treatment
    Conservative
    • Relative rest: bed rest for up to a week, avoiding driving, lifting objects and heavy physical work
    • Physiotherapy: stretching exercises followed by sthrengthening exercises
    Medical
    • NSAIDs
    • Steroid injections may relieve pain but do not speed up recovery
    Surgical

    Surgery, when pain persists for more than 3 months despite physiotherapy. Emergency indications: bilateral symptoms, urinary or bladder incontinence, progressing worsening of symptoms, numbness in the perineum. Surgical options include:

    • Disc removal (discectomy) with spinal fusion
    • Decompression surgery: Removal of a posterior part of the vertebra (laminectomy) or a part of the vertebra near the intervertebral joints (foraminotomy)
    • Minimally invasive surgery: laser discectomy, percutaneous endoscopic lumbar discectomy, nucleoplasty, chemonucleolysis

    Surgical treatment of degenerative disc disease