The causes of back pain are nearly as numerous as terms used to describe the symptoms. Back pain is a primary reason people seek medical attention. Considering that almost 80% of the adult population will encounter some form of back pain, it could be said that back pain is a universal epidemic. Back pain recognizes no age, economic, or ethnic barriers.

Herniated Disc
A disc herniation is a disc rupture. This may occur if the nucleus pulposus (gel-like center) erupts through the annulus fibrosus (protective disc wall) or if the annulus fibrosus fragments. The progression to an actual herniation varies from slow to sudden onset of symptoms.

There are four stages:

(1) disc protrusion,
(2) prolapsed disc,
(3) disc extrusion, and
(4) sequestered disc.

Stages 1 and 2 are referred to as incomplete, where 3 and 4 are complete herniations.

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Sciatica
The term ‘sciatica’ is commonly used to describe pain that travels along the sciatic nerve, the largest nerve in the body. The pain may be sharp, dull, burning, or accompanied by intermittent shocks of shooting pain beginning in the buttock traveling downward into the back of the thigh and leg. The most common cause of sciatica is a herniated disc in the lumbar spine.

 

Lumbar Spine: Sciatic Nerve
(1) Sciatic Nerve (yellow) (2) Sacrum (3) Hip

 

 

 

Compression Fracture
A compression fracture is a common fracture of the spine that may range from mild to severe. Each vertebral body is separated from the other with a disc. When an external force is applied to the spine, such as from a fall or carrying a sudden heavy weight, the forces may exceed the ability of the bone within the vertebral body to support the load. This may cause the vertebral body to crush. This is known as a compression fracture. If the entire vertebral body breaks, this is considered a burst fracture.

Spinal Stenosis
Spinal stenosis results when the small neural passageways termed ‘foramen’ narrow. The narrowing of the foramen may compress and entrap nerve roots. Nerves react to pressure by swelling, which further reduces foraminal space. Stenosis can cause excruciating pain, numbness, tingling, or burning in the involved extremity (e.g. leg, arm). Stenosis can also occur with compression from a disc, osteophytes (e.g. bone spurs), and ligaments.

Scoliosis
Scoliosis causes the spine to curve laterally to the left or right and affects children and adults. Scoliosis is a complex three-dimensional disease. To understand this concept, consider that in some cases, as the spine abnormally curves, the involved vertebrae are forced to rotate. At the thoracic level, vertebral turning impacts the rib cage and may result in rib prominence on the opposite side of the curve. Deformity is the primary complaint. Back pain from scoliosis is uncommon.

Spinal Infections (Osteomyelitis)
Osteomyelitis is a bone infection usually caused by bacteria. In the spine it is commonly found in the vertebrae, although the infection can spread into the epidural and/or intervertebral disc spaces. Typically, symptoms include persistent and severe back pain exacerbated by movement, swelling, fever, sweating, weight loss, and malaise.