Back Pain

Low back and neck pain are extremely common in today's society. It has been estimated that 75% of all people will experience back pain at some time in their lives, and that this problem accounts for 15% of sick leaves. The total cost in lost productivity is enormous.

The good news is that the vast majority of these people, probably greater than 90%, will recover completely without surgical treatment. Only 2 to 3% of people with back pain have a herniated disc, and about 1% have compression of a nerve root.

Definitions

Sciatica

Pain radiating (travelling) into the buttock, back of the thigh, and often into the calf and foot. This is usually caused by irritation of a nerve root of the sciatic nerve, often from compression by a disc or degenerative disease.

Radiculopathy

Dysfunction of a nerve root by any cause. The motor manifestations are weakness, while the sensory manifestations may consist of pain (sciatica), numbness, or tingling (paresthesias), or a combination of these.

Mechanical Back Pain

Also called "back strain" or "musculoskeletal back pain." This diagnosis excludes anatomic sources of pain, such as disc herniation, spondylosis, etc. The causes may be multifactorial, including strain of the paraspinous muscles (the muscles along the spine), strain the the ligaments of the spine, degenerative facet joint disease (the joints between the bones of the spine), or others.

Herniated Disc

Also called herniated nucleus pulposus (HNP), disc rupture, disc prolapse. This condition and its treatment are discussed later in this section.

Spinal Stenosis (Spondylosis)

Narrowing of the spinal canal, typically in the lumbar or cervical spine (lower back and neck, respectively). This is a complex problem requiring an individualized approach for each patient, by an experienced neurosurgeon or neurologist. This condition is discussed later in this section.

Evaluation of Back Pain

The evaluation of back pain requires a physician experienced in this problem. The workup begins with a detailed history and physical examination. Your physician will ask about the quality of the pain, where it radiates, factors which worsen or alleviate the pain, and other questions. The physical examination concentrates on motor and sensory function.

Radiographic evaluation may be indicated. The first step is usually a set of plain X-rays. If your physician is suspicious of a structural lesion, based on the history and exam, one or more additional studies may be performed:

• CT scan (computed tomography)
• MRI (magnetic resonance imaging)
• Myelogram and CT scan

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