Spinal pain

Pain in the spine (dorsopathy) is a universal body language that indicates disorders in the body. There are almost as many causes as there are terms to describe symptoms.

Spinal discomfort is the main reason why people seek medical help. Almost 80% of the adult population faces this problem. Back pain causes significant disability and can be a problem that persists from childhood into adulthood.

Dorsopathy affects almost every aspect of life. Sleep is disrupted and it becomes difficult to bend, reach or turn. Difficulty occurs when driving, walking, lifting, and doing physical exercises. If you have pain in your spine, you should see a doctor immediately. The specialist will study the medical history, take an anamnesis and carry out an examination. If violations are detected, conservative or surgical treatment is prescribed.

Why does my spine hurt?

Dorsopathy is caused by muscle tension and cramps. Tension can be the result of hard physical work, awkward postures and even poor posture.

Studying the anatomy of the spine can help understand the problem on a deeper level. Main parts of the spine:

• The cervix is a mobile section that is subject to degenerative changes. As we age, pain often occurs in the so-called "transition zone" between the flexible cervical vertebrae and the stiffer thoracic part of the spine.
• Ribcage – connected to the chest and connected to the ribs. Compression fractures can occur in this area due to bone loss, particularly in older adults.
• Lumbar vertebrae – lower back. Young patients are more susceptible to discogenic low back pain, while disorders of the joint structures are more common in older patients.
• Sacral – the lowest part of the spine. It consists of a flat, triangular sacrum that connects to the hips and tailbone. Degeneration of this area usually occurs in older patients or after a fall.

Between the upper back and the coccyx there are 17 vertebral bodies, many joints, the sacrum and coccyx as well as fibrous and muscular supporting structures, intervertebral discs, the spinal cord and nerve roots as well as 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 normally consists of 33 vertebrae, each 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.

The back muscles are divided into three groups:

• moderate – responsible for the movement of the ribs;
• internal – stabilize the spine, control the movement and position of the spine;
• superficial – provide movement of the neck and upper limbs.

The muscles that support the spine are built in layers. They act as the main stabilizers of bone and ligament structures. Tension in these muscles is possible in patients of different age groups.

There are other parts of the spine that should be considered when determining dorsopathy. These include ligaments and tendons, intervertebral discs and joints, which ensure stability and mobility.

Inflammatory diseases, malignancies, pregnancy, trauma, osteoporosis, nerve root compression, radiculopathy, plexopathy, osteochondrosis, disc herniation, spinal stenosis, sacroiliac joint dysfunction, facet joint damage, and infection are all part of the differential. Distinguishing the signs and symptoms of nociceptive (mechanical) pain from radiculopathy (neuropathic dorsopathy) is an important first step in making the diagnosis.

Degenerative pathologies

Degeneration includes endplate-related changes (sclerosis, defects, modal changes, and osteophytes) and disc changes (fibrosis, annular fissures, desiccation, height loss, and mucinous annular degeneration).

Degenerative changes in the intervertebral disc are already observed in a third of healthy people between the ages of 21 and 40. When assessing spinal problems, the high prevalence of asymptomatic degeneration should be taken into account.

As we age, the intervertebral disc becomes more fibrous and less elastic. Degenerative changes progress when the structural integrity of the posterior anulus fibrosus is compromised by overload. This eventually leads to the formation of tears in the annulus fibrosus. A herniated disc is defined as a displacement of disc material (cartilage, nucleus, fragmented annular tissue, and apophyseal bone) beyond the disc space.

Rachiocampsis

The natural curves of the spine are important to ensure its strength, flexibility, and ability to distribute load evenly. There is a normal range of natural curves. Abnormal curvatures include lordosis, kyphosis and scoliosis.

Abnormal lordosis

Lordosis, a spinal disease, is a severe inward curvature of the spine. Although this condition most commonly affects the lumbar spine, it can also develop in the cervical spine.

The normal range of lordosis is between 40 and 60 degrees. Changes in posture can lead to unsteady gait and changes in figure - the buttocks become more noticeable. Causes of abnormal lordosis: spondylolisthesis, osteoporosis and obesity.

Abnormal kyphosis

Kyphosis, a spinal disorder, is defined as excessive outward curvature of the spine and can result in forward leaning. It most commonly affects the thoracic or thoracic-lumbar region, but can also occur in the neck region.

The normal range of kyphosis is between 20 and 45 degrees. However, when a structural abnormality results in the development of a kyphotic curvature outside of this normal range, the curvature becomes abnormal and problematic. Manifested by rounding the shoulders and tilting the head forward.

Scoliosis

Defined as an abnormal lateral curvature of the spine. Scoliosis is a progressive structural disease. Lordosis and kyphosis are characterized by a curvature of the spine backwards or forwards. Scoliosis is an abnormal sideways 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% are due to neuromuscular, congenital, degenerative and traumatic causes.

Developmental abnormalities

The symptom often occurs in developmental disorders and can be combined with neurological manifestations.

Dorsopathy occurs with the following developmental anomalies:

• Cleavage – small bone defects cause moderate discomfort in the lumbosacral area. After some time, radicular syndrome occurs.
• Lumbalization, sacralization - compression of the roots is accompanied by stabbing or burning pain. Sensitivity disorders or paresis may also occur.
• Wedge-shaped vertebrae – Discomfort occurs when you exert stress and maintain a static posture for a long period of time. Accompanied by breast deformation and poor posture.

osteoporosis

Typically affects the thoracic and thoracic-lumbar spine and can cause debilitating pain. This disorder is caused by a loss of bone mineral density, resulting in brittle bones.

Osteoporosis can cause vertebral compression fractures, loss of height, stooped posture, and even a hunchback. To prevent osteoporosis, it is necessary to maintain a balanced diet and stop smoking and alcohol abuse. An active lifestyle is also recommended.

Injuries

The severity of dorsopathy corresponds to the severity of the injury. As a rule, it is accompanied by signs of damage to the nerve tissue.

Traumatic causes of pain in the spine:

• A bruise occurs from a direct blow or a fall on the back. Dorsopathy is local and moderate in severity. Gradually disappears within 1-2 weeks.
• Dislocation – occurs due to a high-energy impact. Accompanied by severe pain in combination with impaired sensitivity and motor skills. The general well-being also suffers.
• Spondylolisthesis is a traumatic injury to the spine in the lumbar region. Dorsopathy radiates into the legs and there is a positive symptom of axial strain.
• Compression fracture – occurs when falling on the buttocks or jumping from a height. The pain is initially stabbing, then becomes more intense and worsens with movement.

Pathological fractures that occur against the background of osteoporosis or tumors are manifested by mild discomfort, excruciating 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 treatments. Dorsopathy increases at rest and decreases with exercise. Over time, the mobility of the spine becomes restricted and thoracic kyphosis forms.

Pain in the spine also occurs with tuberculosis. Deep local discomfort is characteristic of the destruction of the vertebrae. Dorsopathy increases with physical activity and is accompanied by excessive skin sensitivity. Stabbing and radiating pain is caused by compression of the nerve roots. The condition is complemented by stiffness of movement.

In osteomyelitis, intense dorsopathy is noted. The disease is diagnosed in patients in childhood and adolescence. Characterized by hematogenous nature. The symptoms increase with movement, so the patient remains in bed. Osteomyelitis is accompanied by fever, weakness and local swelling.

Arachnoiditis is manifested by pain radiating to the area of innervation of the nerve roots. The symptoms become constant and resemble sciatica. There are also motor disorders, sensory disorders and loss of the ability to control the pelvic organs.

Tumors

Benign neoplasms have a hidden course or are accompanied by slowly progressing and mild symptoms. The most common is hemangiomas, which only occur in 10-15% of cases. The discomfort is painful, local. Worsens at night and after physical activity. Neoplasia of the spinal cord is associated with radicular pain and impaired nerve conduction.

Sarcomas of the spine in the primary stage of progression are manifested by moderate, intermittent pain that increases at night. Accompanied by impaired motor activity and radicular syndrome. The complaints are localized in the internal organs, legs or arms (taking into account the location of the tumor).

Other diseases

Discomfort in the spine is also observed in:

• Spinal epidural hemorrhage – similar to the signs of radiculitis, accompanied by spinal conduction disorder.
• Calvet's disease - radiates to the legs, occurs periodically and is mild. It decreases when lying down and increases with physical activity.
• Forestier disease – localized in the chest area, spreading to the lower back or neck. The symptoms are usually short-lived. May be accompanied by pain in the elbow or shoulder joints. Stiffness of the spine cannot be ruled out.

Dorsopathy sometimes occurs in psychological disorders. In this case, the clinical picture is unusual - it does not fit into 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, likely due to osteoporosis and vertebral compression fractures.

Professional activities also lead to back pain. Anyone who has to maintain a static posture for a longer period of time, such as dentists or salespeople, is more likely to be affected by this problem than others. Office workers suffer from upper back pain due to poor workplace ergonomics.

Dorsopathy can occur in different parts of the spine. The localization area indicates the cause of the symptoms and makes diagnosis much easier.

Pain on the right side

The cause is excess weight, a herniated disc or myositis. Kyphosis also causes discomfort on the right side of the back.

Somatic pathologies include salpingitis, inflammation of the ovaries, nephritis and cholecystitis. Appendicitis and the presence of stones in the organs of the urinary system should also be highlighted.

Pain on the left side

The back on the left side hurts due to splenitis (inflammation of the spleen), urolithiasis, oophoritis, duodenitis and pinched roots. Discomfort over 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 spine. This is because it carries a huge load. When the nerve roots are damaged, an inflammatory process occurs. Hernia bulging and osteochondrosis are also possible.

Less commonly, the cause is a combination of prostatitis and urethritis, a violation of the structure of bone tissue, reduced density, lumbar sciatica, arthritis, spinal tuberculosis. In most cases, lower back pain is chronic.

Pain in the lower back area on the right

Dorsopathy occurs when:

• myositis;
• Tuberculosis;
• scoliosis;
• osteomyelitis;
• Spondylitis.

May indicate the presence of a neoplasm. Speaking of radiculitis. Indicates liver dysfunction.

Pain in the left lumbar region

The symptoms mainly occur after physical activity. After rest the condition returns to normal. If the symptoms do not subside when you rest, it is referred to as scoliosis, osteochondrosis, inflammation of the spine and circulatory disorders.

Pinched nerve

In the vast majority of cases, the sciatic nerve is pinched (sciatica). At the same time, its myelin sheath is not damaged. Most often it develops against the background of osteochondrosis. Accompanied by acute, severe symptoms radiating to the lower back, sacrum and lower extremities.

The roots of the spinal nerves are also compressed in compression radiculopathy. The cause is a herniated disc or a reduction in the distance between the vertebrae. You feel "superficial" complaints that become more intense with physical activity, sneezing and coughing.

Intervertebral hernia

It is characterized by an extrusion (bulging) 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 small amount of stress leads to the progression of the pathological process. Dorsopathy is sharp and acute, radiating to the leg or arm.

Pain in the shoulder blades

Based on the type of dorsopathy, a presumptive diagnosis can be made:

• dull, growing – stomach ulcer;
• acute, worse with movement – intercostal neuralgia;
• Numbness of the hands, pressure changes, dizziness – osteochondrosis;
• Radiation below the collarbone – aggravation of angina pectoris.

Pain along the spine and in the back

Develops due to pinched nerve endings against the background of curvature of the spine. If the symptoms are not clearly expressed, one can speak of a bulge. Increased symptoms indicate osteochondrosis, myositis or fracture.

Severe discomfort along the spine indicates wear or thinning of the intervertebral discs. May indicate spondyloarthritis. The pain is constant and sharp.

Pain below the waist

Most often they occur with spondyloarthrosis and osteochondrosis. It is less commonly observed in diseases of the female genital area (oophoritis, cervicitis, endometritis, etc. ). They can occur during pregnancy, during menstruation, with appendicitis and ulcerative colitis. In men, diseases of the bladder or prostate indicate this.

diagnosis

First, a physical examination is performed to identify signs that indicate the need for further testing. The medical examination includes the following procedures:

• Examination of the back and posture to detect anatomical abnormalities.
• Palpation/Percussion of the Spine – Assessment of the condition of the spine and painful areas.
• Neurological examination – assessment of reflexes, spinal sensitivity and gait characteristics. In patients with suspected radiculopathy, the neurological examination should focus on the L5 and S1 nerve roots.

Patients with a psychological disorder that causes back pain may have accompanying physical symptoms, also called Waddell syndrome. These include patient overreactions during physical examination, superficial tenderness, and unexplained neurological deficits (e. g. , sensory loss, sudden weakness, or jerky movements during motor examination). The presence of multiple Waddell signs suggests a psychological component to dorsopathy.

Treatment of spinal pain

In the case of dorsopathy, treatment should be carried out by a doctor. The specialist refers the patient for examination and, based on the results obtained, prescribes effective therapy.

Additional therapeutic measures should be used with caution and after consulting a doctor. Any type of medication carries possible risks and side effects, so self-medication is unacceptable.

Help before diagnosis

Basic home remedies that can be effective in combating mild to severe pain from muscle tension include:

• Short rest period. Many episodes of back pain can be relieved by avoiding physical activity. It is not recommended to rest for more than 2-3 days as prolonged inactivity will hinder healing.
• Change in activity. It is recommended to stay active but avoid activities and postures that worsen dorsopathy. For example, if sitting in a car or at a table for a long time causes discomfort, you should do a warm-up every 20 minutes.
• Exposure to heat or cold. A heating pad or a warm bath relaxes tense muscles, improves blood circulation and thus reduces discomfort. If your lower back hurts due to inflammation, you can use ice or cold compresses to reduce the swelling.

The most common over-the-counter medications for dorsopathy are ibuprofen, naproxen, and acetaminophen. The medications reduce inflammation and relieve lower back pain.

Conservative therapy

Oral drug therapy:

• Analgesics. Patients are prescribed medications from the anilide group, for example paracetamol. Provide a long-lasting analgesic effect. They have a synergistic effect with NSAIDs and are used in combination to enhance pain relief without increasing toxicity.
• Non-steroidal anti-inflammatory drugs. They have pain-relieving properties. In higher doses they have an anti-inflammatory effect.
• Muscle relaxants. They have a central effect and influence the activity of the muscle stretch reflexes. 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 painkillers. Tricyclic antidepressants relieve chronic pain. Low doses may be enough to control symptoms. They do not work immediately and may need to be continued for several weeks before improvement in symptoms is seen. May play a role when complaints are mediated by both peripheral and central mechanisms.

For some patients with back pain, local or regional anesthesia administered by injection is part of the treatment regimen. The injection site may 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. For the relief of intervertebral hernias, spinal canal stenosis and radiculopathy. Reduce dorsopathy and quickly restore sensory functions.

surgery

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, particularly with progressive neurological motor deficits;
• radicular symptoms not amenable to conservative treatment.

The choice of surgical intervention depends on the characteristics of the spinal injury. The operation is most effective when the patient's clinical picture is dominated by manifestations of nerve compression. The most common problem is inadequate neuronal decompression. Comorbidities such as hip arthritis, osteoporosis and cardiovascular disease.

Surgery for patients with radicular pain due to a herniated disc is primarily performed through decompression. Any protruding, extruded, or isolated disc material is removed. The nerve root is examined and released.

prevention

Complications are largely determined based on etiology. They are divided into physical and social. The first include chronic pain, deformities, neurological effects with motor or sensory deficits, and intestinal 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 body's protective functions;
• lift heavy objects correctly;
• undergo a preventive medical examination.

It is important not to slouch and to keep your back straight. The sleeping and working space must be properly organized. It is recommended to do light gymnastic exercises every day after waking up. You should also balance your diet by enriching your diet with foods with sufficient vitamins and minerals. It is recommended to take a contrast shower in the morning.