spinal pain

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

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

Dorsopathy affects almost all aspects of life. Sleep is disturbed and it is difficult to bend, reach or turn. Difficulties arise when driving a car, walking, lifting objects and doing physical exercises. If you have pain in the spine, you should immediately consult a doctor. The specialist will study the medical history, collect a history and conduct an examination. If any violation is detected, conservative or surgical treatment is prescribed.

Why does my spine hurt?

The cause of dorsopathy is muscle tension and spasm. Tension can be the result of hard physical work, uncomfortable positions, and even poor posture.

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

• The cervical is a mobile segment subject to degenerative changes. With age, pain usually appears in the so-called "transition zone" between the flexible cervical vertebrae and the more rigid thoracic part of the spine.
• Thoracic: connected to the thorax and ribs. In particular, older adults may experience compression fractures in this area as a result of bone loss.
• Lumbar – lower back. Young patients are more likely to suffer from discogenic low back pain, while older patients are more likely to experience disorders of joint structures.
• Sacrum: the lowest part of the spine. It consists of a flat, triangular sacral bone that connects to the hips and tailbone. Degeneration of this area usually occurs in elderly patients or after a fall.

Between the upper back and the tailbone are 17 vertebral bodies, many joints, the sacrum and tailbone, as well as fibrous and muscular supporting structures, intervertebral discs, the spinal cord, 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 is usually made up 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.

The muscles of the back are divided into three groups:

• intermediate - responsible for the movement of the ribs;
• internal - stabilizes the spine, controls the movement and position of the spine;
• superficial - provides movement of the neck and upper extremities.

The muscles that support the spine are structured in layers. They function as the main stabilizers of bone and ligamentous structures. Tensions of these muscles are possible in patients of different age groups.

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

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

Degenerative pathologies

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

Degenerative changes in the disc are already observed in a third of healthy people between 21 and 40 years old. 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. A herniation is defined as the displacement of disc material (cartilage, nucleus, fragmented annular tissue, and apophyseal bone) beyond the intervertebral 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 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.

The normal range of lordosis is considered to be between 40 and 60 degrees. Changes in posture can cause instability in 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 an excessive outward curvature of the spine and can cause a forward bend. It most commonly affects the thoracic or thoracolumbar regions, but can also occur in the cervical region.

The normal range for kyphosis is considered to be between 20 and 45 degrees. But when a structural abnormality results in the development of a kyphotic curve outside of this normal range, the curvature becomes abnormal and problematic. It manifests itself 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 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, diagnosed between the ages of 10 and 18. The remaining 20% is due to neuromuscular, congenital, degenerative and traumatic causes.

Developmental anomalies

The symptom usually appears with developmental defects and can be combined with neurological manifestations.

Dorsopathy is present with the following developmental abnormalities:

• Division: In case of small bone defects, moderate discomfort occurs in the lumbosacral region. After some time, radicular syndrome occurs.
• Lumbarization, sacralization: compression of the roots is accompanied by stabbing or burning pain. Sensitivity alterations or paresis may be added.
• Wedge-shaped vertebrae: discomfort occurs when exerting tension and maintaining a static position of the body 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 a loss of bone mineral density, which causes brittle bones.

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

Injuries

The severity of the dorsopathy corresponds to the severity of the injury. As a rule, it is combined with signs of damage to nervous tissue.

Traumatic causes of pain in the spine:

• A bruise is the result of a direct blow or fall to the back. The dorsopathy is local, moderate. It gradually disappears in 1 or 2 weeks.
• Dislocation: Occurs due to high energy impact. Accompanied by severe pain in combination with a disorder of sensitivity and motor activity. The general condition is also affected.
• Spondylolisthesis is a traumatic spinal injury in the lumbar region. Dorsopathy radiates to the legs, there is a positive symptom of axial loading.
• Compression fracture: occurs when falling on the buttocks or jumping from a height. At first the pain is acute, then it becomes intense and progresses with movement.

Pathological fractures that occur against the background of osteoporosis or tumors are manifested by minor discomfort, persistent and painful 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 lower back. There is a characteristic circadian rhythm: symptoms appear at night and intensify in the morning. The intensity decreases after physical activity and aquatic procedures. Dorsopathy increases at rest and decreases with movement. Over time, spinal mobility is limited and thoracic kyphosis forms.

Also, pain in the spine occurs with tuberculosis. Deep local discomfort is characteristic of vertebral destruction. Dorsopathy increases with exercise and is accompanied by excessive skin sensitivity. With stabbing and radiating pain, we are talking about compression of the nerve roots. The condition is complemented by rigidity of movement.

With osteomyelitis, severe dorsopathy is seen. The disease is diagnosed in patients of childhood and adolescence. Characterized by its hematogenous nature. The discomfort increases with movement, so the patient remains in bed. Osteomyelitis is accompanied by fever, weakness and local swelling.

Arachnoiditis is manifested by pain that radiates to the zone of innervation of the nerve roots. The symptoms become constant and resemble sciatica. They are complemented by motor alterations, sensitivity disorders and loss of the ability to control the pelvic organs.

Tumors

Benign neoplasms have an occult course or are accompanied by few symptoms and slow progression. Most often hemangiomas appear, appearing only in 10-15% of cases. The 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 spine in the primary stage of progression are manifested by intermittent moderate pain, which intensifies at night. Accompanied by limitation of motor activity and radicular syndrome. The discomfort is localized in the internal organs, legs or arms (taking into account the level of location of the tumor).

Other diseases

Spinal discomfort is also observed with:

• Spinal epidural hemorrhage: similar to signs of radiculitis, accompanied by spinal conduction disorder.
• Calvet's disease - radiates to the legs, occurs periodically and is mildly expressed. It decreases when lying down, increases during physical activity.
• Forestier's disease, located in the thoracic region, extends to the lower back or neck. Symptoms are usually short-lived. It may be accompanied by pain in the elbow or shoulder joints. Spinal rigidity cannot be ruled out.

Dorsopathy sometimes occurs with 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 15-19% of people worldwide. Postmenopausal women are at increased risk, probably due to osteoporosis and vertebral compression fractures.

Professional activities also cause 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 suffer from this problem than others. Office workers experience upper back discomfort due to poor workplace ergonomics.

Dorsopathy can occur at various points in the spine. The localization area indicates the cause of the discomfort and greatly facilitates the diagnosis.

Pain on the right side

The cause is excessive body weight, a herniated disc or myositis. On the right side of the back, discomfort also occurs with kyphosis.

Among the somatic pathologies are salpingitis, inflammation of the ovaries, nephritis, cholecystitis. Also worth noting is appendicitis and the presence of stones in the organs of the urinary system.

Pain on the left side

The back on the left 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 prone than others to the development of pathological processes in the spine. This is due to the fact that it withstands a colossal load. When nerve roots are damaged, an inflammatory process develops. Hernial protrusion and osteochondrosis are also possible.

Less commonly, the cause is a combination of prostatitis and urethritis, disruption of the structure of bone tissue, decreased density, lumbar sciatica, arthritis and spinal tuberculosis. Discomfort in the lower back in most cases is chronic.

Pain in the right lumbar area.

Dorsopathy occurs when:

• myositis;
• tuberculosis;
• scoliosis;
• osteomyelitis;
• spondylitis.

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

Pain in the left lumbar region.

The discomfort is mainly localized after physical activity. The condition returns to normal after rest. If the discomfort does not disappear at rest, then we are talking about scoliosis, osteochondrosis, spinal infections and circulatory disorders.

pinched nerve

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

Spinal nerve roots are also compressed during compression radiculopathy. The cause is a herniated disc or a decrease in the distance between the vertebrae. A "superficial" discomfort is felt, which sharply intensifies during exercise, when sneezing and coughing.

intervertebral hernia

It is characterized by 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 nucleus compresses the spinal cord. Even a light load leads to the progression of the pathological process. Dorsopathy is acute and acute, radiating to the leg or arm.

Pain in the shoulder blades

Depending on the nature of the dorsopathy, a presumptive diagnosis can be determined:

• dull, growing – stomach ulcer;
• acute, worsening with movement – intercostal neuralgia;
• numbness of the hands, pressure changes, dizziness – osteochondrosis;
• radiating below the clavicle: exacerbation of angina pectoris.

Pain along the spine and in the back.

It develops due to pinched nerve endings against the background of the curvature of the spine. If the symptoms are not clearly expressed, we can talk about 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

Most often they occur with spondyloarthrosis and osteochondrosis. It is seen less frequently 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 bladder or prostate.

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 identify anatomical abnormalities.
• Palpation/percussion of the spine: evaluation of the condition of the spine and painful areas.
• Neurological examination: evaluation of reflexes, spinal sensitivity and gait characteristics. For patients with suspected radiculopathy, neurological examination should focus on the L5 and S1 nerve roots.

Patients with a psychological disorder that contributes to back pain may have accompanying physical signs, also known as Waddell signs. These include patient overreaction during physical examination, superficial tenderness, and unexplained neurological deficits (eg, sensory loss, sudden weakness, or jerking movements during motor examination). The presence of multiple Waddell signs indicates a psychological component of dorsopathy.

Treatment of spinal pain.

In cases of dorsopathy, treatment must be carried out by a doctor. The specialist refers the patient for 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 medication 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:

• Short rest period. Many episodes of low back pain can be relieved by eliminating physical activity. Resting for more than 2-3 days is not recommended, as prolonged inactivity impedes healing.
• Change of activity. It is recommended to remain active, but avoid activities and body positions that worsen dorsopathy. For example, if sitting for long periods of time in a car or at a table increases discomfort, then 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 due to 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. The medications 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. 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.
• Non-steroidal anti-inflammatory drugs. They have analgesic properties. In higher doses they have an anti-inflammatory effect.
• Muscle relaxants. They act centrally, influencing the activity of 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 analgesics. 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. It plays a potential role when distress is mediated by both peripheral and central mechanisms.

Local or regional anesthesia, administered by injection, is part of the treatment regimen for some patients with back pain. 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. It is used to alleviate the condition of intervertebral hernias, spinal stenosis and radiculopathy. Reduces dorsopathy and quickly restores 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, 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 injury. The operation is most effective when the patients' clinical picture is dominated by manifestations of nerve compression. The most common problem is inadequate neuronal decompression. Associated diseases including hip arthritis, osteoporosis and cardiovascular diseases.

Surgery for patients with radicular pain due to a herniated disc primarily involves decompression. Protruding, extruded or insulated disc material is removed. The nerve root is examined and released.

Prevention

Complications are largely determined by etiology. They are divided into physical and social. The first includes chronic pain, deformity, neurological effects with motor or sensory deficits, intestinal or bladder damage. In social terms, complications are often measured by disability and decreased performance.

Patients of all ages should:

• eliminate bad habits;
• live an active lifestyle;
• strengthen the protective functions of the body;
• lift heavy objects correctly;
• undergo preventive examinations with a doctor.

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