Backache:
Among adults, one of the most common medical complaints is back pain or backache which refers to pain in muscles, intervertebral joints, spinal nerves, or sometimes bone-on-bone pain.
It can be upper or lower backache. Upper backache may be due to disorders of the aorta, tumors in the chest, and spine inflammation. Lower back pain may be associated with the bony lumbar spine, discs between the vertebrae, ligaments around the spine and discs, spinal cord and nerves, lower back muscles, abdominal and pelvic internal organs, and the skin around the lumbar area.
Back pain is categorized into :
• Acute pain is often temporary and can improve on its own, frequently without treatment or with the assistance of mild pain-relieving medication, and lasts for up to 6 weeks.
• Chronic pain can often be progressive, getting worse over time, lasts for over 3 months, and causes ongoing problems.
Causes:
The human back is composed of a complex structure of muscles, ligaments, tendons, discs, and bones, which work together to support the body and enable us to move around .The segments of the spine are cushioned with cartilage-like pads called discs.
Problems with any of these components can lead to back pain.
• Osteoporosis in spine
• Strain or spasm of muscles and ligaments
• Injury or fracture of the spine
• Structural problems- Ruptured discs, bulging discs, sciatica, arthritis
• Kidney stones or kidney infections
• Abnormal movement and poor posture
• Cauda equina syndrome
• Spinal tumors
• Infection of the spine and Pelvic inflammatory disease
• Sleep disorders
Risk factors:
• Age
• Obesity
• Improper lifting
• Lack of exercise
• Smoking
• Psychological conditions
• Postural stress
Symptoms:
Back pain can range from a muscle aching to a shooting, burning, or stabbing sensation. In addition, the pain may radiate down to one or both legs and extends below the knee or worsen with bending, twisting, lifting, standing, or walking.
It can cause weakness, numbness, or tingling in one or both legs.
PIVD ( Prolapsed, herniated, or extruded intervertebral disc):
The intervertebral disc is a disc-shaped circular tissue present between the adjacent vertebrae. The disc acts as a cushion between two vertebrae and provides stability.
The intervertebral discs consist of a thick fibrous outer layer known as the annulus fibrosis composed of concentric layers of thick fibers which imparts it the property of elasticity while being tough and a soft center known as the nucleus pulposus which has a watery gel-like consistency giving it the ability to resist compression and allow cushioning action.
A disc herniation results from the protrusion/extrusion of the nucleus pulposus through the annulus fibrosis of the disk. The herniated disk causes inflammation and impinges/compresses the nerves/spinal cord causing symptoms of pain.
Stages of PIVD:
• It has four stages:
• (1) Bulging: At this early stage, the disc is stretched and doesn’t completely return to its normal shape when pressure is relieved. It retains a slight bulge at one side of the disc. Some of the inner disc fibers could be torn and the soft jelly ( nucleus pulposus ) is spilling outwards into the disc fibers but not out of the disc.
• (2) Protrusion: At this stage, the bulge is very prominent and the soft jelly center has spilled out to the inner edge of the outer fibers, barely held in by the remaining disc fibers.
• (3) Extrusion: In the case of a herniated spinal disc, the soft jelly has completely spilled out of the disc and now protruding out of the disc fibers.
• (4) Sequestration: Here some of the jelly material is breaking off away from the disc into the surrounding area.
Special tests for PIVD:
• SLR test
• Laesegue test
• Bowstring test
• Femoral stretch test
Treatment of PIVD:
1). Conservative management:
A]. Rest
B]. Anti-inflammatory and analgesic drugs
C]. Reduction: Continue bed rest and traction for 2 weeks may reduce the herniation in over 90% of cases. If no improvement with rest and traction, epidural injection of a corticosteroid and local anesthetic is given.
D]. Chemonucleolysis: dissolution of the Nucleus Pulposus by percutaneous injection of a proteolytic enzyme (chymopapain).
2). Surgical management:
Indications-
(a) Cauda equina compression syndrome that does not clear up with 6 hours of starting bed rest and traction (emergency).
(b) Neurological deterioration while under conservative management
(c) Persistent pain and signs of sciatic tension after 3 weeks of conservative treatment.
The disc is removed by the following techniques:
A]. Hemilaminectomy/Partial laminectomy
B]. Laminectomy
C]. Microdiscectomy
D]. Fenestration
Video by - Dr. Shivraj Singh, Content by - Dr. Mukta Meel