Understanding Back Pain
It’s estimated that at least 80 percent of all people experience a significant amount of lower back pain at some point in their lifetimes. And at any given time, at least 15 percent of all individuals say they are experience pain at that exact moment. Many even consider lower back pain a natural part of life.
It’s difficult to quickly identify the source of most people’s pains, largely because there are so many possibilities. Muscles, bones, soft connective tissues, ligaments, joint capsules, cartilage and blood vessels can become pulled, strained, stretched or sprained. Even if the actual tissue damage is minor, the pain can be quite severe.
Regardless of how the back is initially irritated, it initiates a cascading set of events that lead to substantial pain. When tissues of the back are aggravated, the body releases chemical substances in response. These substances actually stimulate the surrounding pain-sensitive nerve fibers, resulting in a significant pain sensation. Some of these substances even cause further inflammation and swelling, which also contributes to back pain. The chemicals associated with this process call for even more chemicals, thus perpetuating a painful cycle.
How serious is back pain?
The seriousness of back pain is relative, because the symptoms are often benign and self limited. But sometimes it’s the warning sign of a serious malady, such as a ruptured disk, spinal fracture, infection or cancer. If you experience pain in the legs, weakness, or difficulty with bowel or bladder control, contact your doctor immediately. Even if the pain seems benign, call your doctor if it doesn’t subside within a few weeks.
Anatomy of the spinal column
The spinal column is composed of a series of bones, or "vertebrae," that are stacked on top of one another. It is subdivided into four regions: cervical (the neck), thoracic (the chest and trunk), lumbar (lower back) and sacral (the pelvic area). Each region is unique in composition and function relative to its position along the spinal column. Most people have 33 total vertebrae, though some may have 32 or 34. The variations are usually found in the lumbar or sacral regions.
The cervical spine is made up of seven cervical vertebrae. The main function of the cervical spine is to support the weight of the head (approximately 10 to 12 pounds). The cervical spine has the greatest range of motion of all spinal regions, and consists of the smallest vertebrae.
The main purpose of the thoracic spine is to protect the organs of the chest cavity, particularly the heart and lungs. Twelve thoracic vertebrae, with two ribs (one on each side) attached to each run down the upper and mid back, creating the thoracic cage.
The lower back region, or lumbar spine, is made up of the five largest vertebrae in the spinal column. These are arranged in a natural "C" shape, or lumbar lordosis. The lumbar section is the main weight-bearing portion of the spine.
Lastly, the sacrum, or pelvic region, is made up of five vertebrae fused together into a solid unit. There are usually no identifiable spaces between these sacral segments, thus the section is almost entirely immobile.
Each vertebra is unique in size and purpose, depending on their location, yet they all share three basic functional parts: a drum-shaped body designed to bear weight and withstand compression, a posterior (backside) arch and the transverse process, to which muscles attach. When the vertebrae are stacked on top of one another, they form the spinal canal, which contains the spinal cord.
What is a herniated disc?
Each vertebra is connected by a disc and two small joints called facet joints. The discs hold the vertebrae together and act like shock absorbers. They are made of a tough outer layer called the annulus fibrous and a gel-like center called the nucleus pulposus.
As you get older, the center of the disc may start to lose water content, which makes the disc less effective as a cushion. As a disc deteriorates, the outer layer can also tear. This can allow displacement of the disc's center into the space occupied by the nerves and spinal cord. This is what’s known as a herniated, or ruptured, disc. The herniated disc can then press on the nerves and cause pain, numbness, tingling or weakness.
How are herniated discs repaired?
If your doctor decides that surgery is the best option, he or she will likely perform a discectomy, a spinal fusion or a laminectomy.
Discectomy
When a surgeon performs an open discectomy, he or she surgically removes part of the damaged disc to alleviate pressure on the nerve tissues. It involves a small incision over the site, removal of some ligament and bone material to gain access to the disc, then the removal of some of the disc material itself.
Spinal fusion
Fusion is a technique in which two or more vertebrae are united (or "fused") together so that motion becomes impossible between them. The concept is similar to that of welding, although the surgeon doesn’t "weld" the bones during surgery. Instead, he or she places bone grafts around the site. As the body heals, it fuses the vertebrae together over the course of several months.
Laminectomy
A laminectomy or laminotomy (a partial laminectomy) is often called a "decompression procedure." Lamina are like bony shingles that overlay the nerves within the spine, and can be removed in whole or in part to expose those nerves. By gently moving the nerves out of the way, a surgeon can address a hernia located on the front side of the spine.
What about non-surgical treatments?
Not all back pain requires surgery. And in many cases that do require invasive surgery, it is usually used as a last option when non-surgical methods prove ineffective.
Prescription and over-the-counter antiinflammatory and pain-relieving medications often alleviate back pain, as do more powerful drugs such as muscle relaxants and narcotics. Physical therapy is another popular option.
Why can’t I just "deal" with back pain?
Back pain directly impacts all areas of our lives. It affects mood, which in turn affects our ability to cope with pain. It also affects interpersonal temperament. Depression, irritability and frustration run rampant, affecting our relationships with our friends and families.
In short, it ruins our quality of life. Considering the technologies and wisdom that doctors have at their disposal, it is usually possible to pinpoint and eliminate most back pain altogether.