Spinal pain can affect any level of the spine: cervical (neck), thoracic (chest), or lumbosacral (lower back). However, the neck and lower back are the most vulnerable to pain disorders. Causes of back and neck pain can be attributed to almost every component of the spinal complex. The following is an incomplete list of pain generators.
In an attempt to heal itself following injury, bone tends to form new bone leading to an “overgrowth” of bony tissue (also called spurring) which is termed osteoarthritis. This excess bone can occlude the foramina (openings) in the spinal column through which spinal nerves must pass thus causing nerve root impingement and irritation with resulting numbness, tingling and/or weakness.
Bony overgrowth (spurring of the vertebral endplates) can also cause narrowing of the spinal canal. Prominent osteoarthritis of the neck is called cervical spondylosis. Symptoms consist of neck pain and stiffness with inability to turn or bend the neck fully.
If cervical spondylosis compresses the cervical spinal cord, the condition is called cervical stenosis and the resulting impairment in spinal cord function is called cervical myelopathy. Cervical myelopathy presents with numbness and tingling in the arms or legs, difficulty walking and loss of bladder and bowel control.
With aging, particularly in postmenopausal women, a loss of bone mineral density can lead to osteoporosis. Osteoporosis is a significant risk factor for vertebral compression and hip fractures.
The intervertebral discs lie between adjacent vertebrae in the spine. Each disc is composed of an inner semi-fluid material (nucleus pulposus) surrounded by an outer ring of fibrocartilage (annulus fibrosus). Over time, degenerative changes occur in the annulus leading to small, large and even complete tears in the fibrocartilage.
This results in a bulging or herniated disc. The annulus contains nerve fibers which transmit pain signals to the brain in the event of injury. Most herniated discs protrude in a posterolateral direction which causes impingement and irritation of the spinal nerve root as it exits the cord. Clinically, this presents as sciatica.
Paraspinal muscles (and ligaments) of the back can be overstretched or torn leading to muscle strain. This injury is commonly referred to as a “pulled muscle.” Persistent, recurrent or chronic myofascial pain may represent myofascitis.
Each vertebra abuts against its adjacent vertebrae by way of bilateral facet joints. These are true joints (like the knee or the shoulder) with a lining of cartilage and encased synovial fluid. The facet joints are aligned in such a way as to permit flexion and rotation of the spine.
Much like any other joint in the body, the facet joints are susceptible to arthritis. This condition is referred to as facet joint syndrome. Facet joint syndrome must be distinguished from disc disease since both can cause sciatica.
Irritation of a particular nerve root due to a herniated disc at a specific level or localized foraminal narrowing can lead to loss of sensation or paresthesias (tingling sensation) in the dermatomal distribution of that nerve and/or motor weakness in the muscle groups supplied by that nerve.
Nerve root impingement can occur within the spinal canal. The cervical spinal cord is particularly susceptible to compression due to spinal stenosis (narrowing of the spinal canal due to arthritis, disc bulging and thickening of ligaments). Significant compression of the cervical cord results in a condition called cervical myelopathy.
With several potential sources of pain in the neck or back, it can be complicated to figure out what’s causing a painful condition. The Pain Management Doctors in Las Vegas with the Nevada Pain Network are the top physicians at figuring out the source and providing the top pain relief.
The providers are Board Certified pain management doctors and Las Vegas chiropractors, and have won the Patient’s Choice Award 5 years in a row. Over 50 insurances are accepted at several locations.
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Perina, D.B. (2012). Mechanical Back Pain. Medscape. Retrieved from http://emedicine.medscape.com/article/822462-overview