Weakening of the bones is fairly common in old age and may also occur in younger people who are in poor health. When this loss of structural strength affects the vertebrae of the spinal column, even a slight increase in pressure on them – perhaps due to a fall or sudden vigorous activity – can cause cracks and fractures, especially in the mid – and lower back.

Compression Fracture

Causes of Vertebral Compression Fracture

Osteoporosis is the most common cause of bones (including the vertebrae) becoming weaker and more susceptible to injury. The condition causes loss of minerals from the bones, making them less dense and more fragile. It mainly affects women after the menopause, due to hormonal changes, but men also develop osteoporosis to some degrees as they age. If you are a heavy smoker, alcoholic, do little exercise, or have suffered from an eating disorder (such as anorexia) and are still underweight and very thin, you have a high risk of developing osteoporosis.

Symptoms and Diagnosis for Vertebral Compression Fracture

If you fracture a vertebra, you will feel a sudden, severe pain in he area of your back where the injury has occurred. Damaged vertebra in your lower back may also cause pain around your pelvis and, if any nerves are irritated, numbness and tingling in your legs. In the upper part of your back, the pain may radiate around your chest and make breathing difficult. You may find it hard to move around, and even lying down can cause pain; coughing or sneezing may hurt too. This pain and lack of mobility is likely to take several weeks to subside. Your doctor may arrange for a CT or an MRI scan to assess the extent of the fracture.

Treatment of Compression Fractures

Treating the osteoporosis with medicines and calcium and treating the pain with analgesics. A brace or corset is sometimes recommended, to keep the back stable as the bones heal. Surgery may be needed if there is any loss of function because of bone pressing on the spinal cord or spinal nerves.

Risks and Recovery

Without treatment the shape of your spine and your posture may be permanently affected. While the pain lasts you are likely to find it difficult to perform everyday activities.

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These linked conditions generally affect your lower back but may occur in any part of your spine. Spondylolysis occurs when a defect or weakness in a vertebra is then at risk of slipping out of line with the vertebrae adjacent to it, leading to spondylolisthesis, which can be debilitating and painful, or may be painless and go unnoticed.

Causes of Spondylolysis & Spondylolisthesis

Spondylolysis may start with a minor crack across the narrow arch of bone in a vertebra, known as the neural arch. In some cases, this crack is present at birth, but usually it is the result of a fall or due to strain and overuse. Some sports, such as cricket and football, repeatedly put stress on the arches of the vertebrae, which can lead to minor cracks or breaks. Spondylisthesis generally develops from spondylolysis, with the crack widening to a complete break due to further stresses and strains. This break allows the damaged vertebra  to slip out of line, which can irritate the linked facet joints and ligaments and possibly trap a nerve.

Symptoms and Diagnosis for Spondylolysis & Spondylolisthesis

The pain from a displaced vertebra due to spondylolisthesis depends on the degree of slippage. A slight slip may cause little or no pain, while a greater degree of slippage can lead to more intense pain because of the irritation to the spinal joints and ligaments. If your nerve is trapped, there may be some pain, numbness, or “pins and needles” in one or both of your legs. Your doctor will make a diagnosis is through a physical examination and testing including an X-ray, MRI scan, and myelogram.

Spondylolisthesis

Risks and Recovery for Spondylolysis & Spondylolisthesis

Back-strengthening exercises can help stabilise your posture, but where vertebrae have severely slipped, nerve entrapment can develop that may require surgery. Young people diagnosed with spondylolisthesis should avoid contact sports and activities with a high risk of back injury. A young person who is still growing should be monitored every six months, using X-rays to detect further movements and shifts in the spinal column. Once growth stops, the vertebrae are unlikely to slip any further.

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Acute attacks of low back pain commonly afflict young and middle-aged adults. They can occur with little warning, or can develop slowly over a number of days. In about half of these cases, no obvious trigger for he pain can be identified. The pain can be severe and temporarily disabling, and last for 10-14 days on average.

Lower Back Pain
Lower Back Pain

Causes

The causes of acute low back pain may include a fall or stumble, repeated heavy lifting, an awkward bend, prolonged bending and stooping, or a cough or sneeze. Occasionally it may occur suddenly, without any obvious cause, such as waking in the morning and finding it impossible to get out of bed. The actual physical causes of the pain are probably one of the following: acute dysfunction of a segment of the lumbar spine, lumbar disc internal disruption or herniation, irritation of a sciatic nerve, a sacroiliac strain, ligament strain or, very occasionally, a muscle strain. Accompanying muscle “spasm” is a common result of these strains, but is not the cause in itself.

Symptoms

The symptoms of acute low back pain are sharp pain, either centrally or to one side of your lower back, with an intense dull aching which can spread further into your buttocks, groin, and even thighs. Muscle spasm can grip your spine – known as “splinting” – causing immobility and stiffness; the pain may be worse with one or two particular movements such as bending forwards, backwards, or sideways, and you find it hard to sustain some positions, such as sitting, for long.

Risks and Complications

Normally, episodes of acute low back pain will resolve within a few weeks without the need for specific treatment, and the threat of any serious complications as a result of them is very small. The main risks are associated with resting for too long, which can cause stiffness. You may become fearful of any movement because of the memory of the initial pain or the idea that any pain caused by moving means further harm. Rarely, a disc strain can develop into cauda equina syndrome, when the disc prolapses or herniates fully into the spinal canal and damages the nerves that run into the legs, bladder, and bowels.

Treatment – Acute Lumbar Dysfunction

Immediate

  • If you suspect your pain is caused by acute lumbar dysfunction, you should:
    • take painkillers for the first few days of pain

Short Term

  • If after 3 days, you are still unable to move, you should:
    • seek medical attention.

Medium Term

  • If after 7-10 days you are not able to resume normal activities, you should:
    • consult a doctor for further treatment.

Long Term

  • If after 6-8 weeks you are not recovering as expected, your doctor may:
    • arrange investigations such as an X-ray, MRI or blood tests.

Treatment – Disc Herniation and Sciatica

Sciatica
Sciatica

Immediate

  • If you suspect your pain is caused by sciatica, you should:
    • consult a doctor for examination and diagnosis

Short Term

  • If the pain increases when you are upright, you should:
    • lie flat for short periods.

Medium Term

  • If after 7-10 days you are unable to resume normal activities, consult a doctor, who may:

Long Term

  • If after 6-8 weeks you are not recovering as expected, you should:
    • seek further advice from your doctor, who may arrange MRI.
  • If you have not responded to physiotherapy within 3 months, then:

Treatment – Sacroiliac Strain

Immediate

If you suspect your pain is caused by acute lumbar dysfunction, you should:

  • take painkillers for the first few days of pain

Short Term

  • If, after 3 days, the pain has not settled, you should:
    • consult a doctor

Medium Term

  • If, after several weeks, you are still unable to resume normal activities, you should:
    • consult your doctor for further examination, advice, or treatment.

Long Term

  • If, after 6-8 months, you still have recurring pain, you should:

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Pain in the mid-back or thoracic spine (also known as the dorsal spine) usually arisen in similar ways to pain the lower back or neck, except that disc protrusions are less common and nerves are less likely to be trapped. Thoracic pain should always be investigated by a doctor.

Spine Anatomy
Spine Anatomy

Causes of Thoracic Spine Pain

Acute attacks may be caused by a fall or stumble, repeated heavy lifting, an awkward bend, a violent twist or wrench, a cough or sneeze, or a trivial uncoordinated movement, such as turning over in bed or getting up from a chair. The actual physical causes are probably due to mechanical dysfunction: a facet or rib joint strain or protrusion. More long-standing pain that develops gradually may be related to scoliosis.

Symptoms of Thoracic Spine Pain

The thorax houses important organs, such as the heart and lungs, which can refer pain to the front, side, or back of the chest. Symptoms include central or one-sided thoracic pain: it may hurt more when coughing, sneezing, or breathing deeply, and it invariably hurts to rotate the trunk in one direction more than the other. Central, severe pain that is made worse by bending forwards or backwards and radiates through to the front directly is more suggestive of a disc problem. In an older person who is coughing violently,a stress fracture of a rib is a possibility. Similarly, a young athlete may develop a stress fracture through repetitive strain, or may pull or tear one of the large muscles of the back in a violent movement. Pain that is worse a night may signify an underlying illness or disease. Pain may be referred to the abdomen or as low as the groin in any of the above conditions.

Risks and Complications

It is important that you rule out any potentially serious causes of thoracic pain, as it may be linked to diseases of the heart, aorta, lungs, pancreas, or kidneys. Infection in a disc or vertebra involves the thoracic spine more than any other area of the back. Very rarely, the cause of pain is secondary cancer.

Treatment – Mechanical of Thoracic Spine Pain

  • If you have acute thoracic pain of mechanical origin, you should:
    • see a doctor
    • use ice pack
    • take pain killers
    • try not to rest for more than 3 days
  • If your condition is slow to improve, you should:
    • consult a physiotherapist for treatment
  • If after 14 – 21 days you are not able to resume normal activities, you should:
    • consult your doctor for further examination, advice or treatment.
  • If after 6-8 weeks, you are not recovering as expected, you should:
    • seek further advice from your doctor, who may consider arranging investigations such as an MRI or blood test.

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If you have suffered from a neck problem for three months or more, your pain will be described as “chronic”. The pain may be severe or mild, constant or intermittent; these factors will determine the degree to which it affects your life.

Neck Pain
Neck Pain

Causes of Chronic Neck and Nerve Root Pain

Precise causes of chronic neck pain are often difficult to determine. In more than 50% of sufferers, it stems from the facet joints as a result of osteoarthritis, spondylosis, or a previous trauma such as a whiplash injury. If you have nerve-root pain, the most probable cause is a prolapsed disc. Less common causes of chronic neck pain include myofascial pain.

Symptoms of Chronic Neck and Nerve Root Pain

The symptoms of chronic of  neck pain are similar to  those of acute neck. Older people with degenerative changes in their neck may experience grinding or grating when moving, causing stiffness and aching. Recurrent episodes of more disabling pain can be triggered by trivial movements such as rotating your neck suddenly, jolting or jarring, and extending your neck or bending forwards for sustained periods of time. Numbness, pins and needles, and weakness in your hands may be a sign of cervical myelopathy – when the spinal cord in the neck is squeezed by degenerative changes in the bones and discs, leading to impairment of the nerves, affecting the arms and sometimes the legs – or spinal cord compression. Advanced cervical myelopathy may affect walking and gait. Chronic nerve-root pain may cause neuropathic features – when a nerve or nerves are damaged over a long period, leading to abnormal processing of pain – such as burning sensations. Mood and sleep patterns may become disturbed; the impact of the pain on your life can cause frustration and sometimes depression.

Risks and Complications for Chronic Neck and Nerve Root Pain

The physical risks of chronic neck pain are associated with the more serious conditions of major disc prolapse or cervical myelopathy leading to spinal cord compression. Other significant complications of chronic pain relate to its effect on your life, work, relationships, mood, and fitness.

Treatment for Facet Joint Pain

  • If your pain has been diagnosed as being caused by a facet joint problem, you should
    • take painkillers
    • start physiotherapy
  • If your pain is moderate to severe,and you have not improved with physiotherapy, you should see a specialist. The specialist may:
    • perform MRI and injections to the neck.
  • If the specialist decides that injections are not appropriate or are not working, he may:
    • suggest a functional rehabilitation programme
    • suggest an operation
  • If a more specific diagnosis leading to effective treatment has not been made
    • use medication wisely and appropriately.

Treatment for Myofascial Pain Syndrome

  • If your pain has been diagnosed as being caused by a myofascial problem, you should:
    • take painkillers
    • start physiotherapy
  • If you are still in pain, your doctor may refer you to a specialist, who may:
    • consider giving you a low dose of an antidepressant to relax your muscles and improve sleep quality.
    • identify trigger points. If these are found, he may use trigger-point injections.
  • If after several months you are still in pain, your specialist may:
    • suggest a functional rehabilitation programme.

Treatment for Disc-Related Pain

  • If your pain has been diagnosed as disc-related, you should:
    • take painkillers
    • start physiotherapy
  • If your pain is moderate or severe and it has not improved with physiotherapy, then you should see a specialist. He may:
    • perform MRI.
    • offer further treatment, such as prolotherapy.
  • If your spine has degenerated of the disc is badly damaged, your specialist may:
    • suggest surgery
  • If your specialist feels that treatment is not working,
    • a functional rehabilitation programme to improve the range of motion.
    • suggest surgery
  • If treatment has improved your symptoms, you should:
    • continue to practice good neck care

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