Spine Anatomy

Our spine is a complex anatomy, due to the complexity, there are different kinds of pain cause by different parts of the spine, such as:

  • Pain from Facets
  • Pain from Discs
  • Pain at the End of the Spine
  • Pain due to Wear and Tear

Pain from Facets

As we age, we lose height, primarily because the discs that separate the vertebra dry out and shrink. The vertebrae become more closely opposed, and the facets take on undue weight. Facets are designed more to create stability than to bear weight. This excess wear causes them to degenerate, and some arthritic and hurt, at times chronically. As they become arthritic, they may also calcify (harden with deposits of calcium from the body) and become deformed. The excess calcification of these joints may bulge into the spinal canal and foramen, pressing on the nerves there. This may contribute to spinal stenosis, the narrowing of spinal canal.

Spinal Stenosis

Pain from Discs

Discogenic pain comes from a tear in the annulus, with no disc material oozing out onto a spinal nerve. This kind of pain usually is described as deeper than facet pain, but the two frequently coexist. Discs are deeper in the spinal structure than the facets and pain from them cannot easily be provoked by poking the area around the spine. Both facet and discogenic pain may be one-sided but often affect both sides of the back.

Lumbar-disc-related pain (either discogenic pain or pain from disc herniation) is usually worse during the day. It may exist at night and impair sleep. Many postures and activities make it worse: standing, walking, sitting, rising from a bent position, and bending down. Less commonly, lying in bed, with the spine curving into the mattress, may irritate the torn disc or a lumbar nerve compromised by a herniated disc. Anything that puts vertical or bending-related stress of a degenerated, painful disc may worsen the pain.

Cervical-disc-related pain is worse at night because you turn your head while you sleep. It may also cause pain during the day when you turn your head to look around. When your head bounces around on your neck, such as when you are riding in a car over a rough road, it may also cause pain if you have cervical disc problems.

Thoracic-disc-related pain is rare. When it does not occur, it may cause pain in he back or even travel partway around the chest along a rib. Thoracic disc herniation sometimes results in pain that may be confused with other ailments, like heart disease or reflux of the oesophagus.

Pain at the End of the Spine

The sacrum itself is rarely a cause of pain unless it is fractured or its connection to the lumbar spine is altered. In people with normal bones, sacral fracture may occur from a severe fall. People with severe osteoporosis can fracture the sacrum even fro minor trauma. Various types of sacral tumours can cause local pain and damage to the nearby nerves that control bowel and bladder.

Pain in the area of the sacrum also occurs after fusion surgery in which the lumbar spine is surgically fused to the sacrum at L5-S1. Sacral pain following this type of fusion is perhaps the most common cause of severe chronic sacral pain in the noncancer patient population. Occasionally, sacral pain is due to sore or tight muscles. It may exist while walking, standing, or sitting.

Chronic, severe tailbone – coccyx – pain is rare. This is fortunate, since it is often difficult to treat. Most people with such pain – coccydynia – complain of pain in the tailbone while sitting. It usually develops following a fall on their rear end, usually squarely backward, as on an icy sidewalk. The tailbone can also be invaded by tumours, which cause pain and often bowel dysfunction.

Pain due to Wear and Tear

The spine wears out from stress. The lumbar spine (lower back) supports the most weight and is the most common area for spine-related pain. The are of greatest spinal degeneration is the lower lumbar spine, attached to the fixed pelvis. The lower cervical spine, just above the shoulders, is the second most likely area to degenerate over time. Consequently, the lumbar and cervical areas have the greatest propensity for disc herniations. (The thoracic spine is least likely to cause chronic pain).

The vertebrae themselves may cause pain if fractured by day-to-day trauma, suffer an osteoporotic collapse, are weakened by a blood vessel malformation, or invaded by a tumour. If a piece of fractured vertebra presses on the nerves in the spine or spinal cord, serious, possibly permanent pain, weakness, and numbness or bowel and bladder disturbance may result.

Another problem occasionally seen is a birth defect involving a hole in the bone in the back of the L5 vertebra that disconnects the stabilising facet joint on the side of the defect from the rest of the vertebrae. Over time, this may destabilise the spine, allowing slippage. This type of defect is called spondylolysis. Spondylolisthesis occurs when a vertebral body slips out of place with respect to the one above or below it, causing spinal instability. Think of that gooseneck lamp is no longer in line with the others. This may result in narrowing of the spinal canal and foramen underlying the area of slippage, resulting in pressure on the nerve roots there. This pressure may become a source of chronic pain, weakness, and numbness unless the spinal instability is surgically corrected.

Key Points to Understand Your Back Pain

  • The spine is a mechanical masterpiece with many components that can be damaged by injury or aging.
  • The lumbar back is the most common site for spinal pain, followed by the cervical area just above the shoulders.
  • Most back pain is muscular and improves with time, rest and, at most, conservative treatment.
  • Much spine-related pain can be prevented by some lifestyle modifications, such as controlling weight.
  • Back pain can also be caused by medical diseases.

Back Pain Specialist

Dr Mathew Tung

Dr Mathew Tung Neurosurgeon

Book Appointment Online for Back Pain Treatment

Sprain and Strain

Cervical sprains and strains involve an overstretching or tearing in the supporting tissues of the neck. A sprain results from injury to the ligaments and a strain from injury to the muscles or muscle tendon. Sprained or strained tissue becomes tender to the touch, and results in stiffness, swelling and reduced range of motion in the neck. Other associated symptoms can include headache, dizziness, numbness, tingling, pain or weakness in the arms.

Cervical sprains and strains typically occur together and are usually a result of one of two common causes: long-term or excessive physical activity or sudden trauma. These types of injuries frequently occur in people whose occupation requires excessive or repetitive use of their arms or awkward head positions, such as working on an assembly line, in car repair, and even working in an office at a computer with poor ergonomics. Sudden trauma, such as an car accident, fall or sports injury, can also cause cervical sprains and strains.

Whiplash is a common cause of a sprain / strain injury. It is also the most common type of injury resulting from a motor vehicle accident. The force at impact causes sudden, excessive extension (backward motion) and then rapid flexion (forward motion) of the neck. A more severe ligament injury can even cause instability of the spine. This can be detected in routine x-rays. Whiplash motion can also cause trauma to the facet joints. Other, more serious injuries to the vertebrae or intervertebral discs are possible but less likely.

Whiplash Injury
Whiplash Injury

People usually report pain from whiplash shortly after an accident, but sometimes the pain doesn’t begin until several days later. After the injury, the muscles surrounding the neck and head stiffen up. Over time, this stiffness may spread from the neck to the upper back muscles. Associated symptoms can occur, including headaches, dizziness, and arm pain or tingling.

Most of the time, your body heals from whiplash, with minimal treatment, over the course of several weeks. Treatment includes heat application, oral  anti-inflammatory medications or muscle relaxants and physical therapy.


Arthritis is inflammation and stiffness of a joint that may result in swelling and restricted motion. Arthritic disorders can complicate neck pain in many people.

Osteoarthritis is a degenerative joint disease that occurs in everyone as they age and tends to worsen over time. In fact, osteoarthritis occurs in everyone as they age and tends to worsen over time. In fact, osteoarthritis occurs in more than half the population over age 50. That said, only some of these people suffer chronic pain. Osteoarthritis in the neck can be precipitated by an earlier trauma or degenerative disc disease. Increased friction, inflammation, and bone formation occur because of a mechanical breakdown in the cartilage lining the joint.

Over time, as a response to everyday stressors, our bones thicken to stabilise the spine. When excessive thickening occurs, the extra bone (called bone spurs, or spondylosis) can causes pain by compressing or irritating the exiting the spinal nerve roots (spinal stenosis) or small nerves that supply the facet joints. Excessive bone formation can also extend into the spinal canal, compressing  the spinal cord.

Several factors can increase the likelihood of developing severe osteoarthritis. Age is the primary and most predictable reason for osteoarthritis, often starting at around age 30. Work or sports related repetitive motion, or poor body mechanics, can set the stage for arthritis, particularly if you are overweight, because excess pounds place more stress on your joints. Genetic predisposition. poor circulation, or disease – such as diabetes – can also promote the onset and development of osteoarthritis.

Stiffness and pain are common features of osteoarthritis. These symptoms are typically at their worst first thing in the morning, lessening slightly as you become more active after rising. The pain can even awaken a person during the night. Many people with osteoarthritis experience a steady aching pain that is worsened by neck motion. Some people note that this pain becomes most acute during times of major weather changes. This is thought to be related to fluctuations in the barometric pressure and the heavier air that a low-pressure weather front brings.

Much less common types of arthritis include rheumatoid arthritis, psoriatic arthritis, gout, and ankylosing spondylitis.

Disc Disease

The number one question that people with neck or upper back pain ask their doctors is if a slipped disc is the cause of their pain. Although it is probably the most common concern, it is not the most common cause of neck pain. Surprisingly, many people with a disc problem do not experience neck pain.

When disc disease is the cause of pain, it typically results in compression or chemical irritation of a spinal nerve root. The fibrous outer shell of the disc (annulus fibrosis) can become torn or cracked by an acute injury or by chronic wear. The back (posterior) of the disc is most susceptible to this type of damage, which can also lead to herniation of the inner nucleus pulposus. Small tears in the disc can heal over time, but recurrent or large tears can result in bulging disc (an intervertebral disc that extends beyond its normal boundary) or a herniated disc (when the inner nucleus pulposus extrudes through the outer annulus).

Herniated Disc

Large disc herniation in the cervical spine can cause narrowing of the central canal and, as a result, compression of the spinal cord. This compression can cause weakness and numbness not only in the arms but also in the legs. This is not an unusual scenario, yet most people – understandably- fail to attribute leg symptoms to neck problems. More commonly, disc herniation causes narrowing of the spinal foramina, resulting in irritation or compression of a spinal nerve root. The location of the irritation or compression determines where symptoms are experienced in the body. These symptoms can include pain, numbness, tingling, or even weakness and can be present in the neck, upper trunk, or arms. For example, compression of C8 nerve root (at the base of the neck) may result in numbness and tingling in the hand, while irritation of the C5 nerve root (at the middle of the neck) can cause symptoms in the shoulder region. Although some herniated discs require surgical repair, many patients respond to nonsurgical interventions, preventing or delaying a need for surgery. Nonsurgical options are described in the rest of this book.

Radiculopathy and Neuralgia

Radiculopathy is disease of a spinal nerve root. Typically, this disorder results from the compression or physical irritation of a spinal nerve root as it exits the neural foramen. The foraminal space can become narrowed by a disc herniation or by vertebral bone thickening (spurs), causing compression. Or the fluids ordinarily contained within a disc may leak out because of a tear, causing irritation and inflammation in a nearby nerve root. Less commonly, diseases such as shingles or diabetes similar affect the spinal nerve roots by inflaming them. Any one of the eight cervical nerve roots can be involved in a radiculopathy, but the sixth and seventh nerves are the most commonly affected. Cervical radiculopathy can cause not only neck pain but also pain, numbness, and weakness down one or both arms.

Spondylolisthesis and Spondylolysis

Spondylolisthesis is a slipping of one vertebra over another. The most common cause of such slippage is spondylolysis, or a crack in the posterior portion of the vertebra that connects the spinous process to the facet joint. This defect can occur on one or both sides of the vertebra, and it is typically a result of chronic repetitive motion or trauma such as that experienced by professional athletes or industrial workers. Although spondylolisthesis usually occurs in the lower back, it can occur in the neck, especially in people who wear heavy head gear while working, such as welders.

Diagnostic Testing

Your doctor will use diagnostic tests to aid in the evaluation of your chronic neck pain. Each test is designed to look for specific types of abnormalities in the anatomy or function of the cervical spine.

X-ray (radiography) is the most commonly performed diagnostic test for patients with neck pain. The bones of the neck are best visualised with this technique when looking for fractures or other changes to the bones.

Magnetic resonance imaging (MRI), unlike an x-ray, does not expose the body to any radiation. MRIs are more frequently ordered to evaluate possible disc pathology.

Neck and Upper Back Pain Specialist

Dr Mathew Tung

Dr Mathew Tung Neurosurgeon

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