The spine is the main support for the human body and provides protection for the spinal cord. It is comprised of 33 vertebrae that permit the body to maintain an upright position as well as to bend. These vertebrae include not only the articulating bones of three regions of the spine, cervical (neck), thoracic (chest), and lumbar lower back), but also the stationary vertebrae of the sacrum and coccyx that make up the bottom of the spine.
About 80 percent of all adults will suffer significant back pain at some time in their lives. In some cases, the pain is the result of overuse or injury and may heal with or without treatment. In other cases, the pain results from congenital malformations or deteriorative processes and is ongoing. In these cases, reparative surgery may be necessary.
Back pain usually occurs as the result of spinal nerve compression. Common reasons for back pain include:
- Deterioration from arthritic degeneration
- Herniation of a disc
- Sprain, sprain or tear of a muscle, tendon or ligament
- Fracture of a vertebra
- Compression fracture of a facet, the joint between vertebrae
- Spinal stenosis, a narrowing of the spinal canal
Less frequent causes of back pain include disorders such as muscular dystrophy, scoliosis and ankylosing spondylitis, bacterial infections of the spine and spinal tumors. Back pain often worsens as patients age and osteoarthritis and spinal stenosis are more common.
Spinal problems are diagnosed through the use of some combination of the following:
- Physical examination
- Diagnostic imaging tests, like X-rays, CT, MRI or bone scan
- Muscle or bone lesion biopsy
- Electromyogram (EMG)
A wide range of treatments are used for back pain. The more conservative methods of treatment include rest, pain medication, such as nonsteroidal anti-inflammatory drugs (NSAIDs), weight loss, regular exercise, and, in some cases, physical therapy and corticosteroid injections.
When conservative methods do not provide relief, or when the patient’s condition worsens, surgery is considered. Depending on the individual case, the surgery performed may be a discectomy, a disc replacement, a laminectomy, a spinal fusion or a vertebral corpectomy.
Discs between the vertebrae help to cushion the bones and allow for smooth and painless movement. Symptoms arise when part of the disc material begins to protrude, known as disc herniation, or when the disc begins to wear down, known as disc degeneration. These conditions can cause pain that radiates down the arm or leg and weakness or numbness in the affected limb.
As spinal degeneration occurs naturally with age, bone spurs may form and narrow the space in the spinal canal. These bone spurs press on the spinal cord or nerve roots and cause pain.
Kyphosis is an exaggeration of the normal curve of the thoracic spine. While the spine has a natural S-shaped curve, it can curve abnormally as a result of spinal disorders, causing the appearance of a hump. This disorder is most often caused by osteoporosis but may also be the result of a birth defect or injury.
This surgery is performed to remove a disc and any bone spurs that are compressing nerve roots, usually as a result of a herniated or degenerated disc. In some cases, the space left when the disc is removed is filled with an artificial gelatinous disc.
A laminectomy is a minimally invasive procedure performed to relieve pressure on spinal nerves resulting from spinal stenosis or disc herniation. During a laminectomy, a small section of bone that covers the back of the spinal cord (the lamina) is removed. The removal of this portion of bone and any residual bone spurs relieves the pressure on the spinal cord, alleviating pain
During spinal fusion surgery, two or more vertebrae are joined with the use of a donor bone graft which may be taken from another area of the patient’s body or from a donor bank. Metal rods are implanted to ensure spinal stability as the bones grow together.
During a vertebral corpectomy the anterior portion of the spinal cord is removed and bone grafts are used to fill the space. This procedure is performed to relieve and pain due to spinal stenosis. Similar to a discectomy, a corpectomy involves removal of a larger region of the spine.