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 significant levels 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. Difficulty arises when driving a car, walking, lifting and doing physical exercise. If you experience pain in the spine, you should immediately see a doctor. The specialist will review the medical history, collect anamnesis 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 spasms. Strain can be caused by 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 spine:
- The cervix is a mobile segment that is 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.
- Thorax - connected to the chest and connected to the ribs. In particular, older adults may develop compression fractures in this area due to bone loss.
- Lumbar - lower back. Younger patients are more prone to discogenic low back pain, while older patients are more likely to experience disorders of the joint structure.
- Sacral - the lowest part of the spine. It consists of the flat, triangular sacrum bone that connects to the hip and coccyx. Degeneration of this area usually occurs in older patients or after a fall.
Between the upper back and coccyx are 17 vertebral bodies, numerous joints, the sacrum and coccyx, as well as fibrous and muscular supporting 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 that attach to muscles. 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 - stabilizes the spinal column, controls the movement and position of the spine;
- superficial - provides movement of the neck and upper limbs.
The muscles that support the spine are structured in layers. They serve as the main stabilizers of bone and ligament structures. This muscle strain may occur 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 that provide stability and mobility.
Inflammatory disease, malignancy, 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. Differentiating the signs and symptoms of nociceptive (mechanical) pain from radiculopathy (neuropathic dorsopathy) is an important first step in making a diagnosis.
Degenerative pathology
Degeneration includes endplate-related changes (sclerosis, malformations, modal changes and osteophytes) as well as disc changes (fibrosis, annulus tears, desiccation, height loss and mucinous annulus degeneration).
Degenerative changes in the disc are already observed in a third of healthy people aged 21 to 40 years. 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 develop when the integrity of the fibrous structure of the posterior annulus is compromised by overload. This will eventually cause the formation of cracks in the annulus fibrosus. Herniation is defined as the displacement of disc material (cartilage, nucleus, split annular tissue, and apophyseal bone) outside the intervertebral disc space.
Rachiocampsis
The natural curve of the spine is important to ensure strength, flexibility and the ability to distribute loads 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. Postural changes can cause instability in walking and changes in shape - the back becomes more noticeable. Causes of abnormal lordosis: spondylolisthesis, osteoporosis and obesity.
Abnormal kyphosis
Kyphosis, a disorder of the spine, is defined as excessive outward curvature of the spine and can result in a forward tilt. Most often it affects the thoracic or thoracolumbar region, but can also occur in the cervical region.
The normal range of kyphosis is considered to be between 20 and 45 degrees. But when structural abnormalities result in the development of a kyphotic curve outside of this normal range, the curvature becomes abnormal and problematic. Manifested by rounding the shoulders and tilting the head forward.
Scoliosis
Defined as 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 juvenile scoliosis, diagnosed between the ages of 10 and 18. The remaining 20% are caused by neuromuscular, congenital, degenerative and traumatic causes.
Developmental anomalies
These symptoms often occur with developmental disabilities and can be combined with neurological manifestations.
Dorsopathy presents with the following developmental anomalies:
- Splitting – with small bone defects there is moderate discomfort in the lumbosacral region. After some time, radicular syndrome occurs.
- Lumbarization, sacralization - root compression accompanied by shooting or burning pain. Sensitivity disorders or paresis may be added.
- Wedge-shaped spine - discomfort occurs when exerting pressure 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 the loss of bone mineral density, which leads to brittle bones.
Osteoporosis can cause vertebral compression fractures, loss of height, stooped posture, and even stooping. To prevent osteoporosis, it is necessary to ensure a balanced diet, stop smoking and alcohol abuse. An active lifestyle is also recommended.
injury
The severity of 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:
- Bruises are the result of a direct blow or fall on the back. Dorsopathy is local, moderate. Gradually disappear over 1-2 weeks.
- Dislocation – occurs as a result of high energy impact. Accompanied by severe pain in combination 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 are positive symptoms of axial load.
- Compression fracture - occurs when falling on the back or jumping from a height. At first the pain is sharp, then becomes intense and develops with movement.
Pathological fractures that occur against the background of osteoporosis or tumors are manifested by minor discomfort, nagging and excruciating pain. They remain unchanged for a long time.
Inflammatory and infectious diseases
Ankylosing spondylitis is accompanied by stiffness and dull pain in the lumbar region. There is a characteristic circadian rhythm - symptoms occur 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, spinal mobility is limited and thoracic kyphosis is formed.
Also, pain in the spine occurs with dry cough. Deep local discomfort is characteristic of vertebral destruction. Dorsopathy increases with exercise and is accompanied by excessive skin sensitivity. With shooting and radiating pain, we are talking about nerve root compression. This condition is accompanied by stiffness of movement.
With osteomyelitis, intense dorsopathy is noted. This disease is diagnosed in childhood and adolescent patients. Characterized by hematogenous nature. 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 innervation of the nerve root. Symptoms become constant and resemble sciatica. They are accompanied by motor disorders, sensitivity disorders and the loss of the ability to control the pelvic organs.
Tumors
Benign neoplasms have a hidden course or are accompanied by progressive and few symptoms. Often, hemangiomas appear, which only appear in 10-15% of cases. The discomfort is painful, local. Progress at night and after physical activity. Spinal cord neoplasia is accompanied by radicular pain and impaired nerve conduction.
Spinal column sarcomas in the main stage of development are shown by moderate intermittent pain, which increases at night. Accompanied by limitation of motor activity and radicular syndrome. Discomfort is localized in internal organs, legs or arms (taking into account the degree of tumor location).
Other diseases
Discomfort in the spine is also observed with:
- Spinal epidural bleeding - similar to the signs of radiculitis, accompanied by spinal cord conduction disturbances.
- Calvet's disease - radiates to the legs, occurs periodically, is expressed mildly. Decreases when lying down, increases during physical activity.
- Forestier's disease - localized in the thoracic region, spreading to the lower back or neck. Symptoms are usually short-lived. May be accompanied by pain in the elbow or shoulder joints. Spinal stiffness cannot be ruled out.
Dorsopathy sometimes occurs with mental disorders. In this case, the clinical picture is unusual - it does not correspond to the possible symptoms of the disease.
Causes of back pain according to location
Chronic upper back dorsopathy affects 15 to 19% of people worldwide. Postmenopausal women are more at 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 have this problem than others. Office workers experience upper back discomfort due to poor workplace ergonomics.
Dorsopathy can occur at various points in the spinal column. Localization areas indicate the cause of discomfort and greatly facilitate diagnosis.
Pain on the right side
The cause is excess weight, a slipped disc, or myositis. On the right side of the back, discomfort also occurs with kyphosis.
Among the somatic pathologies are salpingitis, ovarian inflammation, nephritis, 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, pinched roots. Discomfort above the lower back indicates inflammation of the serous membrane of the lungs, bronchial damage, ischemia and intercostal neuralgia.
Pain in the lumbar region
The lumbar region more often than others is subject to the development of pathological processes from the spinal column. This is due to the fact that it bears a very large load. When the nerve root is damaged, the inflammatory process develops. Protrusion of hernia and osteochondrosis is also possible.
Less common, the cause is a combination of prostatitis and urethritis, violation of the structure of bone tissue, decreased density, lumbar sciatica, arthritis, tuberculosis of the spine. Discomfort in the lower back in most cases is chronic.
Pain in the right lower back
Dorsopathy occurs when:
- myositis;
- dry cough;
- scoliosis;
- osteomyelitis;
- spondylitis.
May indicate the presence of a neoplasm. Talk about radiculitis. Indicates liver dysfunction.
Pain in the left lumbar region
Discomfort is localized mainly after physical activity. Things return to normal after resting. If the discomfort does not subside during rest, then we are talking about scoliosis, osteochondrosis, spinal infection and circulatory disorders.
Pinched nerves
In most cases, the sciatic nerve is pinched (sciatica). At the same time, the myelin sheath is not damaged. Often it 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 compressive radiculopathy. The cause is a herniated disc or a reduction in the distance between the vertebrae. "Superficial" discomfort is felt, which increases sharply 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 middle part of the extruded core compresses the spinal cord. Even a small load leads to the development of pathological processes. Dorsopathy is sharp and acute, radiating to the legs or arms.
Pain in the shoulder blade
Based on the nature of dorsopathy, a presumptive diagnosis can be determined:
- dull, growing - stomach ulcer;
- acute, aggravated by movement - intercostal neuralgia;
- hand numbness, pressure changes, dizziness - osteochondrosis;
- radiating below the collarbone - exacerbation of angina pectoris.
Pain along the spine and in the back
It develops due to nerve endings that are pinched against the background of the curvature of the spinal column. If the symptoms are not clearly stated, we can talk about protrusion. Increased symptoms indicate osteochondrosis, myositis, or fractures.
Severe discomfort along the spine indicates wear or thinning of the intervertebral disc. May indicate spondyloarthritis. The pain is constant and sharp.
Pain below the waist
Often it occurs with spondyloarthrosis and osteochondrosis. Less commonly observed in diseases of the female genital area (oophoritis, cervix, endometritis, etc. ). They may appear during pregnancy, during menstruation, with appendicitis, ulcerative colitis. In men, indicate bladder or prostate disease.
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 identify 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 walking characteristics. For patients with suspected radiculopathy, the neurological examination should focus on the L5 and S1 nerve roots.
Patients with psychological disorders contributing to back pain may have accompanying physical signs, also known as Waddell's sign. 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.
Spinal pain treatment
In the case of dorsopathy, treatment should be carried out by a doctor. Specialists refer patients for examination and, based on the results obtained, prescribe effective therapy.
Additional therapeutic measures should be used with caution and after consulting a doctor. Any type of medicine comes with 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 caused by muscle tension include:
- A short rest period. Many episodes of low back pain can be relieved by eliminating physical activity. It is not recommended to rest for more than 2-3 days, because prolonged inactivity prevents healing.
- Changes in activity. It is recommended to remain active, but avoid activities and body positions that aggravate dorsopathy. For example, if sitting for a long time in a car or at a desk increases the discomfort, then you should warm up every 20 minutes.
- Exposure to heat or cold. A heating pad or warm water bath relaxes tense muscles and increases 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:
- Analgesic. Patients are given drugs from the anilide group, such as paracetamol. Gives 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. At higher doses they have an anti-inflammatory effect.
- Relax the muscles. They act centrally, influencing the activity of muscle stretch reflexes. The combination of NSAIDs and muscle relaxants provides significant relief from dorsopathy. The main side effects are drowsiness, headache, dizziness and dry mouth.
- Neuropathic pain reliever. 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 are seen to improve. Play 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 may be a localized area of 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. Used to reduce the condition of intervertebral hernia, spinal stenosis and radiculopathy. Reduces dorsopathy and quickly restores sensory function.
Surgery
A small number of people with back pain need 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 deficit;
- radicular symptoms that are not compatible with conservative treatment.
The choice of surgical intervention is determined by the characteristics of the spinal cord injury. This operation is most effective when the clinical picture in the patient is dominated by manifestations of nerve compression. The most common problem is insufficient nerve decompression. Associated diseases include hip arthritis, osteoporosis and cardiovascular disease.
Surgery for patients with radicular pain due to herniated discs mainly involves decompression. 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 includes chronic pain, disability, neurological effects with either motor or sensory deficits, bowel or bladder damage. In social terms, complications are usually measured by disability and decreased performance.
Patients of all ages should:
- eliminate bad habits;
- to lead an active lifestyle;
- strengthen the protective functions of the body;
- lifting heavy objects correctly;
- undergo a preventive examination with a doctor.
It is important not to slouch and keep your back straight. Places to sleep and work must be arranged properly. 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.